Dear Lt. Col. Kulund:
Air Force Surgeon General Charles B. Green has named you as his point of contact regarding Electronic Cigarettes. Would you please discuss the following information with Dr. Green:
Dr. Green appears to be relying upon the FDAs July 2009 press release, rather than the scientific evidence (i.e., the actual lab results) in forming policy. Of several hundred brands of cigarettes, the FDA chose to test the products of only the two companies that had filed a lawsuit against the agency. Thus the FDA had a vested interest in making the products appear to be harmful.
Regarding the whole cartridge (i.e., the non-vaporized liquid), the FDAs actual lab report states: Tobacco specific nitrosamines and tobacco specific impurities were detected in both products at very low levels. DEG was identified in one cartridge.
http://www.fda.gov/downloads/Drugs/ScienceResearch/UCM173250.pdf
E-Cigarette Toxicity
Characterizing diethylene glycol (DEG) as antifreeze in its press release was misleading and inflammatory on the part of the FDA. Actually, a common use for diethylene glycol (DEG) is as a humectant, to keep tobacco moist. The nicotine in the cartridges was extracted from tobacco. The FDA was apparently unconcerned about any danger to human health associated with a 1% concentration of DEG, because they did not impose a recall on Smoking Everywhere cartridges.
In the 7 years that e-cigarettes have been in use world-wide and 2 years in the U.S., there have been no reports of users being poisoned by electronic cigarettes and no reports of any serious adverse events.
In October 2008, Dr. Murray Laugesen of Health New Zealand tested the Ruyan brand of e-cigarette. His report concludes, 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.
http://www.healthnz.co.nz/RuyanCartridgeReport30-Oct-08.pdf
My organization, the Consumer Advocates for Smoke-Free Alternatives Association (CASAA.org), has gathered a collection of lab reports on several brands of e-cigarettes.
CASAA.org
E-Cigarettes Are Not Cancer-causing
You will not find the phrase cancer-causing anywhere in the FDAs publications on electronic cigarettes. The reason for this is that the same tobacco specific nitrosamines (TSNAs) identified in some e-cigarette cartridges are also found in FDA-approved nicotine patches and nicotine gum, in roughly equivalent quantities (8 ng). [See Comment 1 on page 7 of the Health New Zealand report cited above.] This quantity is too small to be considered cancer-causing, which is why the FDA nicotine products do not carry a health warning on their packages about cancer.
A personal aside: I find it despicable that the FDA chose to mislead the public by withholding the extremely pertinent quantitative information about TSNAs in e-cigarette cartridges.
NJOY commissioned a study to determine the presence of TSNAs in its vapor. The results of the study were further verified by an independent research lab. The report found that only one of the 4 TSNAs present in the liquid is present in the vapor form. That particular TSNA, NAT, was shown to be non-toxic and non-carcinogenic by Hoffman, et al. The report concludes, Based on the above, there is no evidence that carcinogenic TSNAs are present in the aerosol from NJOY electronic cigarettes. Thus, it is my conclusion that the TSNAs do not pose a health risk to the users of the electronic cigarettes distributed by NJOY.
http://www.casaa.org/files/Study_TSNAs_in_NJOY_Vapor.pdf
E-Cigarette Vapor versus Tobacco Smoke
Even though smoking accounts for only 80% of all tobacco use, it is responsible for 98% of the tobacco-related disease and death. The reason for this is simple: smoke. Smoke is created by the process of combustion. Thus tobacco smoke contains tar, carbon monoxide, particles of ash, and thousands of chemical compounds created by burning the tobacco and paper. These are the substances that cause the lung disease, heart disease, and cancers associated with inhaling smoke. E-cigarette vapor does not contain any of these harmful substances, because nothing is set on fire and burned.
In the August 2010 issue of Cancer Epidemiology, Biomarkers & Prevention, researchers from Virginia Commonwealth University reported on a clinical trial comparing health effects of subjects own brand of cigarettes to two brands of electronic cigarettes and to sham smoking. Both brands of electronic cigarette significantly decreased tobacco abstinence symptom ratings. Like sham smoking, the electronic cigarettes had no significant impact on plasma nicotine levels, heart rate, or exhaled carbon monoxide.
http://www.casaa.org/files/Virgiania Commonwealth University Study.pdf
Appropriate Package Warnings
The products do contain nicotine, and appropriate warnings about nicotine use can be found on packages. The NJOY cartridge package, for example, states that the products are intended for use by those of legal smoking age and older, not by nonsmokers or children, nursing or pregnant women, or persons with or at risk of heart disease, high blood pressure, diabetes, or taking medication for depression or asthma
Please keep NJOY products out of reach of children and pets; ingestion of certain pieces can cause a choking hazard and ingestion of the non-vaporized concentrated ingredients in the cartridges can be poisonous. The package also states on the side Warning: Nicotine is addictive and habit-forming.
E-Cigarette Intended Use
The NJOY label reads NJOY products are not a smoking cessation product and have not been tested as such. The label also states, If you smoke tobacco products, you are encouraged to stop. Electronic cigarette products are intended to be a replacement for smoking tobacco products. The purpose of supplying various levels of nicotine is to meet the nicotine requirements of users who want to avoid debilitating nicotine abstinence symptoms, as well as the harmful physical effects of inhaling smoke.
E-Cigarette Effect On Human Health
Switching to any smoke-free form of nicotine has positive effects on health. Gartner, et al found There was little difference in health-adjusted life expectancy between smokers who quit all tobacco and smokers who switch to snus.
Assessment of Swedish snus for tobacco harm reduct... [Lancet. 2007] - PubMed result
We estimate that there are at least a half million former smokers in the U.S. who became smoke-free by using an electronic cigarette. Surveys of electronic cigarette consumers give us a good idea of how safe and effective these products are. In one survey, 63% of respondents were using an electronic cigarette as a complete replacement for all their smoked cigarettes, Positive effects reported with ecigarettes included their usefulness to quit smoking, and the benefits of abstinence from smoking (less coughing, improved breathing, better physical fitness).
BioMed Central | Full text | Electronic cigarettes: a survey of users In another survey, 79% were former smokers thanks to electronic cigarettes. Over 90% of respondents stated their health had improved.
http://tobaccoharmreduction.org/wpapers/011v1.pdf
Exposing Former Smokers to Smoke
If 90% of e-cigarette users are experiencing health improvements, it defies all logic to insist that the exhaled vapor could harm bystanders especially in view of the fact that no harmful substances have been found in the vapor.
Ecigarette mist harmless, inhaled or exhaled
If Dr. Green believes that second-hand smoke is dangerous, why is he sending former smokers to the smoking area whenever they want to use the product that allows them to remain smoke-free? Surely people who are using Nicorette gum, a Nicotrol inhaler, or Swedish snus to remain smoke-free are not banished to the smoking section to use their products.
He is also discouraging continuing smokers from switching to a much less harmful alternative. Many people began using an e-cigarette to avoid being sent outside but found, to their surprise, that their interest in smoking real cigarettes had spontaneously disappeared. They had no intention of quitting. It just happened.
Summary
There is a growing body of scientific evidence showing that switching from smoking to using an e-cigarette results in improved health and does not endanger the health of either the user or bystanders.
There is no scientific evidence supporting the contention that e-cigarettes present any danger to the health of users or bystanders. (A press release does not constitute scientific evidence.)
I leave you with this thought from Dr. Michael Siegel, Professor at Boston University School of Public Health:
We in tobacco control should be trying to do everything we can to help smokers quit. Thus, we should be embracing electronic cigarettes rather than putting obstacles in the way of people using this product. The best way to reduce secondhand smoke exposure is to reduce cigarette smoking. Encouraging smokers to quit is the best thing we can do to reduce secondhand smoke, and the use of e-cigarettes to quit smoking seems to be a very effective and popular strategy.
The Rest of the Story: Tobacco News Analysis and Commentary
Please contact me if you need any further information.
Bravo to you both!
