“Study finds e-cigarettes affect airways, and quickly”

[Ande]

There is an unfortunate tendency sometimes to expect a single study to answer all questions definitively: in my experience, such studies are very, very, very rare. The usual case, in my experience, is that individual studies reporting different effects under a variety of experimental conditions lead slowly but inexorably to an eventual answer.

These are wise, moderate, and sensible words.

Problem is, in this media age, they mean less than one might think.

The famous FDA press release of 2009 is a great example- the actual science behind it, though questionable, probably DID add a thing or two to the universal pool of knowlege about ecigs. But it was presented in such a way that it really detracted from the general public's understanding of the issue, by causing them to believe things that simply aren't true.

Half the problem is that the public is too credulous by half.

buy the other half is that researchers (who should know better) present their specific results (which, as Dr E points out are limited to a very specific set of conditions and circumstances) as if they were much more far reaching. Some do it to further an agenda. Some do it for notoriety. Some probably due it in ignorance of the complexity of the issues.

But it's done often. And there's no use in saying "we need to understand the limitations of the studies" when the headlines and abstracts, which is all most people will read, are consciously constructed to mislead.

Best,
Ande

 

[DC2]

But it's done often. And there's no use in saying "we need to understand the limitations of the studies" when the headlines and abstracts, which is all most people will read, are consciously constructed to mislead.

[EOD]

Edit: End of Discussion

In any valid scientific pursuit, the parties in question MUST be non-biased.
If there is bias present, and not controlled for, the study is likely to be biased and skewed.

And that bias may present itself in a number of ways...
--Skewed and biased methodology
--Skewed analytical presentation of the results
--Skewed interpretaton of the results

These are issues that those in this research space are growing used to.
And those in the space of interpreting the results and applying them to real world situations are growing used to.

But at the same time, we are growing more and more tired of it too.

And we are not entirely made of up of a bunch of stupid vapers.
We are a passionate and often intelligent lot.
And we are ready to fight for our very lives.

And this kind of "pseudo-science" should inspire researchers to to dig deeper, and focus on real-world situations and goals.

And we are not ever going to shut up about it.
Because our very lives are at stake here.

 

[Ande]

+1 DC2.

I'd add- it's not just our lives. There are a LOT of people dying as a result of the slow uptake of THR. More than you can count. Maybe more than we can ever calculate.

THIS is why we aren't "nice" to the poor misguided researchers who just have a different point of view. Too many researchers are guilty of skewing results (or sometimes presentation of results) to fit an agenda.

And they have blood on their hands. But so do we if we let them get away with it.


Ande

 

[DC2]

And they have blood on their hands. But so do we if we let them get away with it.

I could not possibly have said it any better.

 

[Thulium]

First, with regard to experimental design, there is in my mind absolutely NO FLAW in including a control condition that involved use of an e-cig without a cartridge. That control condition is a valid one, and is equivalent to the "sham smoking" condition (i.e., puffing on an unlit cigarette) I and others have used for years when studying the effects of cigarette smoking. It controls for any product specific inhalation-behaviors that may influence outcome measures. Now, that having been said, I would have loved to see outcomes measured for OTHER conditions, such as smoking a tobacco cigarette and inhaling from a 0 mg nicotine cartridge. However, and this goes to my point above about systematic progression of science, it is rarely possible to do everything we want in every study we run. What these investigators have reported is an effect that can be measured -- perhaps they intend to explore this effect more thoroughly in subsequent work. Indeed, they may have had financial limitations that this study, with the effect that they report, may help them overcome. I am sorry to say that science rarely moves as quickly as you or I would like it to.

Dr E., I have to respectfully disagree with this assessment. Although puffing on an unlit cigarette may control for the contrictive effect of inhaling through a cigarette filter, the cartridge of the e-cigarette is the "filter" portion of an e-cigarette so this does not provide any more effective control than giving them a AA battery and LESS than if they had given them a sham cigarette that they could use to at least mimic the inhalation pattern. Using an e-cigarette without nicotine or comparing against actual smoking (since the test group were abstinent smokers) or comparing against non-smokers or even comparing against your "sham cigarettes" might have provided at least a modicum of information. This test structure that showed NO statistically significant respiratory effects compared to breathing normally, but only showing a change in the levels of exhaled Nitric Oxide in e-cigarette users compared to holding a useless battery without a cartridge is nearly without any value whatsoever.

In light of the fact that the abstract does not even correctly indicate the smoking status of the test participants is just further proof that this work is so shoddy as to barely even qualify as "junk", much less science.

 

[Tom09]

Dr E., I have to respectfully disagree with this assessment. Although puffing on an unlit cigarette may control for the contrictive effect of inhaling through a cigarette filter, the cartridge of the e-cigarette is the "filter" portion of an e-cigarette so this does not provide any more effective control than giving them a AA battery and LESS than if they had given them a sham cigarette that they could use to at least mimic the inhalation pattern. [...]

Thulium, I hope you’ll excuse this reply by a different user.

To send ahead: hardware used in the discussed study was a standard 510 model (Nobacco BL = Joye 510).

Description in method section of Vardavas et al. (2011) reads as if they just called the atomizer “filter”:

120 […] The electronic cigarette itself was
121 comprised of a steel shell, a microprocessor, powered by a lithium battery and a filter and a
122 removable (and renewable cartridge). […]

Their study design section reads:

110 […] The subjects enrolled in the experimental group were instructed to use the e-
111 cigarette at lib, for 5 minutes as they would usually smoke. The control group subjects were
112 requested to use the e-cigarette with similar frequency, however without the e-cigarette cartridge
113 included and therefore e-cigarette vapor was not created nor inhaled. As vapor was not formed in
114 the control setting, blinding was not possible.

So, if I would be forced to make sense of authors’ written control group sentence: I would assume manual 510 batteries, keep the atomizer attached, remove the carts and suck through the atomizer without pressing button. Certainly not intelligent design. But probably also not highly detrimental when compared with “hold cart attached, just don’t press button” - if the aim is to control for (see teissenb) “product specific inhalation-behaviors”.

Of course, as everyone said, additional comparators (VG base, no nic, analog groups…) would have been helpful. But unfortunately, and for what ever their reason, the authors sticked to the scribbling of a “smallest publishable unit”. As it is, I would say that there are certainly other issues with this publication (and stimulated media echo). Such as: how come that the finding of *lower* FeNO values, experimentially observed for the e-cig users, became touted to the general public as to indicate “inflammation”?

 

[McDougal]

Is this who you wrote to, and basically what he said?

The Rest of the Story: Tobacco News Analysis and Commentary

Yes, that's him.

 

[McDougal]

Dr E., I have to respectfully disagree with this assessment. Although puffing on an unlit cigarette may control for the contrictive effect of inhaling through a cigarette filter, the cartridge of the e-cigarette is the "filter" portion of an e-cigarette so this does not provide any more effective control than giving them a AA battery and LESS than if they had given them a sham cigarette that they could use to at least mimic the inhalation pattern. Using an e-cigarette without nicotine or comparing against actual smoking (since the test group were abstinent smokers) or comparing against non-smokers or even comparing against your "sham cigarettes" might have provided at least a modicum of information. This test structure that showed NO statistically significant respiratory effects compared to breathing normally, but only showing a change in the levels of exhaled Nitric Oxide in e-cigarette users compared to holding a useless battery without a cartridge is nearly without any value whatsoever.

In light of the fact that the abstract does not even correctly indicate the smoking status of the test participants is just further proof that this work is so shoddy as to barely even qualify as "junk", much less science.

My opinion right now is that it was a bit intellectually dishonest to not use smoke for the control sample, then in the conclusion, recommend using so-called "proven" patches, gums and drugs. This reminds me of the FDA study, where it was left out that the e-cigs tested had the same toxicity as other NRTs.

 

[Tom09]

I'd like to get a pdf of the paper. Does anyone have a link to free access?

Find pdf here.

 

[markfm]

Thanks for the study link From reading it, it does sounds like the subjects were truly new to ecigs, just given PV and told to vape them like a cig. Everyone familiar with ecigs knows how harsh they can be right off the bat, as the inhale style for a PV is normally different from smoking.

I like the statement "however as these measurements were performed after only 5 minutes of ad lib e-cigarette use, a normal consumer would use the product most likely many times a day thus the clinical impact might be greater." "Might" is the key word, they are stretching to find negative. They might just as well have said "however an experienced e-cigarette user might develop an inhalation technique appropriate to the device being used, thus the clinical impact might be decreased". The study I linked to several pages back (http://www.medscape.com/viewarticle/755086), testing over multiple months, noted how early reports of irritation spontaneously decreased over time, basically new people figure out how to use PVs with a little time; this is consistent with many real-world PV users as evidenced on this forum, needing some coaching on how to use PV.

 

[kristin]

Thanks for the study link From reading it, it does sounds like the subjects were truly new to ecigs, just given PV and told to vape them like a cig. Everyone familiar with ecigs knows how harsh they can be right off the bat, as the inhale style for a PV is normally different from smoking.

I like the statement "however as these measurements were performed after only 5 minutes of ad lib e-cigarette use, a normal consumer would use the product most likely many times a day thus the clinical impact might be greater." "Might" is the key word, they are stretching to find negative. They might just as well have said "however an experienced e-cigarette user might develop an inhalation technique appropriate to the device being used, thus the clinical impact might be decreased". The study I linked to several pages back (Medscape: Medscape Access), testing over multiple months, noted how early reports of irritation spontaneously decreased over time, basically new people figure out how to use PVs with a little time; this is consistent with many real-world PV users as evidenced on this forum, needing some coaching on how to use PV.

Not only that, but they only tested 3 times, at 30 second intervals, after 5 minutes of use.

The whole maneuver lasted for 90 seconds and was repeated for verification.

That means that they tested lung function for up to 1 1/2 minutes after use. How is lung function at 3 minutes? 5 minutes? 1/2 hour? How do they know that the PG isn't absorbed into the lung tissue after a few more minutes and lung function returns to normal? How does it compare to lung function after smoking a whole cigarette for (typically) about 10 minutes?

All this tells us is the immediate, extremely short-term effects of inhaling vapor did NOT show statistically significant central airway resistance and only showed an "immediate decrease in exhaled FeNO concentrations."

This is like claiming hot pepper sauce may be a health risk because it's immediate effects are irritation to mouth and throat tissue. But we all know that those effects go away relatively quickly. It just seems pointless to test effects for just 90 seconds after use.

 

[Spazmelda]

Find pdf here.

Thanks for posting the link!

 

[Cokeybill]

It's sad that we will all throw out or discount any study that looks negative on ecig use. I've had several smokers try my e-cig and immediatly put it down and start coughing insanely.. Usually they smoke it like a cigarette (direct lung inhale).. That would probably be the reason...

We NEED to know if these are safe.. I think we all had issues in the beginning. And yes, perhaps our bodies have adapted (just like they did to cigarettes), that doesn't mean they are safe..

A sane statement. Although the report is extremely sketchy and bares no real data. The long term isn't known...yet. I hope for all of us that they are safe and no unforetold problems arise. Ecigs are still in the early stages and are better than analogs, but look at the long history of the analog nightmare. Who would have thought back then. Just sayin'.

 

[Thulium]

How are we supposed to take the author of this study seriously as an authority on electronic cigarettes who does not even understand the difference between a healthy smoker and a healthy non smoker or between a filter and an atomizer...and then expects us to believe that a decrease in exhaled FeNo by a few parts per billion is a documented "adverse" reaction?

 

[Thulium]

Buried underneath the ignorant blather in the Abstract, this study is yet another confirmation that electronic cigarettes do not produce polycyclic aromatic hydrocarbons (PAH) and have a smaller reduction in exhaled FeNo than asthma patients undergoing aerobic exercise: Effects of aerobic training on airway i... [Med Sci Sports Exerc. 2011] - PubMed - NCBI

 

[Vocalek]

Well, now we have another candidate for products/substances that researchers could use to compare effects on lung function.

Pot smokers don't puff away lung health: study | Reuters

 

[Tom09]

The authors could have also just compared with the effects of breathing in the cold winter air, if they really wanted to set the findings of their study and concluding call for a ban in an appropriate relation. As I understand it presently, all this paper added is a measurable effect of constriction. Cold air constrincts the airways, too. A similar study group would have instructed their test subjects to take a deep breath of cold air, and detected the measurable effect of constriction. Accordingly, authors’ conclusion would have read like: “The US FDA as other international regulatory bodies should pursue the depopulation of Alaska and Canada, while additional research is warranted so as to obtain concrete evidence of an adverse health outcome. © 2011 American College of Chest Physicians”

 

[Thulium]

The authors could have also just compared with the effects of breathing in the cold winter air, if they really wanted to set the findings of their study and concluding call for a ban in an appropriate relation. As I understand it presently, all this paper added is a measurable effect of constriction. Cold air constrincts the airways, too. A similar study group would have instructed their test subjects to take a deep breath of cold air, and detected the measurable effect of constriction. Accordingly, authors’ conclusion would have read like: “The US FDA as other international regulatory bodies should pursue the depopulation of Alaska and Canada, while additional research is warranted so as to obtain concrete evidence of an adverse health outcome. © 2011 American College of Chest Physicians”

The saddest part to me is that there is no outcry from the greater scientific community about this study (that gleefully pronounces itself the first to find a measurable physiologic effect measurable in the parts per billion) because they must admit that this is in fact, "what passes for 'science' these days."

The reason for the "smallest publishable unit" is either because the authors are attempting to get published recognition as "experts" in this field without actually admitting anything that could rock the boat and/or it is to leave the door open for other rent seeking researchers.

I suspect the reason for not comparing against smoking is a matter of scale and significant figures. The only physiologic effect this study could find was a reduction of exhaled FeNo by a few parts per billion, while studies on smoking show a reduction of exhaled FeNo by .0009 or more which represents a 99.999777...% reduction physiologic effect, so it should be no wonder that the other tests couldn't find anything of statistical significance: Unless they can show an effect with at least 6 significant digits to compare against, it rounds up to 100%.

 

[sheik124]

Study/news article title should read: "Researchers find money in helping out big pharma and big tobacco."

I would much rather vape than smoke or take Chantix. Or pay through the nose for Nicorette.

 

[larrymz]

I quit smoking and went to vaping when i developed COPD. I'd be dead now if i'd stayed on cigarettes.