Article: "Harms of e-cigs re overstated relative to potential benefits..."

[DWG505]

Bummer you have to pay to read the full article, but a good source for pro-e-cig info.

Electronic cigarettes: achieving a balanced perspective - Wagener - 2012 - Addiction - Wiley Online Library

ABSTRACT

Concerns have been raised that the advent of electronic cigarettes (e-cigarettes) may be harmful to public health, and smokers have been advised by important agencies such as the US Food and Drug Administration not to use them. This paper argues that, while more research is needed on the cost–benefit equation of these products and the appropriate level and type of regulation for them, the harms have tended thus far to be overstated relative to the potential benefits. In particular: concern over repeated inhalation of propylene glycol is not borne out by toxicity studies with this compound; risk of accidental poisoning is no different from many household devices and chemicals available in supermarkets; concern that e-cigarettes may promote continued smoking by allowing smokers to cope with no-smoking environments is countered by the observation that most smokers use these products to try to quit and their use appears to enhance quitting motivation; concerns over low nicotine delivery are countered by evidence that the products provide significant craving reduction despite this in some cases; and e-cigarettes may help reduce toxin exposure to non-smokers.

 

[Synnuh]

Looks good. I'm writing a 40-page paper on PVs for my comp 2 course this semester, and need more articles just like this one. <3 I wish there were more scientific, unbiased studies being done to prove or disprove the effectiveness and health aspects of the devices we love so much.

 

[DC2]

Looks good. I'm writing a 40-page paper on PVs for my comp 2 course this semester, and need more articles just like this one. <3 I wish there were more scientific, unbiased studies being done to prove or disprove the effectiveness and health aspects of the devices we love so much.

I hope you have checked out the CASAA website, which would prove to be your best source for such information.

 

[Synnuh]

Yeah, I've dug through there and plan on using some of the information. I need at least 15 different sources, so it will definitely be 1 of them.

 

[Vocalek]

Our Web site is undergoing some changes. Until this gets posted on the new site, here is a copy of the most recent update to our list of E-Cigarette Research articles. Where available, a link to the full article is included.

View attachment Electronic-Cigarette-Research.pdf

Elaine

 

[Tom09]

Electronic cigarettes: achieving a balanced perspective - Wagener - 2012 - Addiction - Wiley Online Library

To read the published journal commentaries (free to access) to Wagener et al.’s discussion article, you may follow this link (Addiction - All Issues - Wiley Online Library), choose “search in this journal”, type “Wagener” and “Siegel” in the search box

 

[DC2]

To read the published journal commentaries (free to access) to Wagener et al.’s discussion article, you may follow this link (Addiction - All Issues - Wiley Online Library), choose “search in this journal”, type “Wagener” and “Siegel” in the search box

Thanks for posting that! There was some interesting stuff in there, including this...

KRALIKOVA - 2012 - Addiction - Wiley Online Library

We approached people who bought cigarettes at five locations across Prague between 10 and 19 October 2011 and conducted brief structured interviews to establish whether the respondents had ever heard about electronic cigarettes; whether they had ever tried one; if so, what was their reaction to it; and what was their subsequent EC use. A total of 973 smokers (average age = 32, 54% men) were interviewed.

A total of 86% (n = 837) of respondents had heard about EC, 26% (n = 253) had tried them at least once, and 7% (n = 69), i.e. 27% of those who had ever tried them, were using them regularly.

Of the 253 respondents who had tried EC at least once, 245 provided information about their reaction, with 43% disappointed with the experience, 33% finding it as expected, and 24% finding EC better than expected.

 

[DC2]

And this commentary by Etter is pretty interesting as well..
ETTER - 2012 - Addiction - Wiley Online Library

 

[Tom09]

And this commentary by Etter is pretty interesting as well..
ETTER - 2012 - Addiction - Wiley Online Library

A key sentence in Etter 2012: “Researchers have lacked curiosity.”
That’s certainly nothing to blame on Etter. He is probably not an outright fan of e-cigarettes - but he has proven himself to be one of the very few actually curious people within the tobacco control community. That‘s a true researcher, that’s a scientist. Anyhow, I would read this related to the vast number of contributions in scientific journals written by so-called researchers, who have just been exploiting scientific methods and formalisms to further a pre-conceived notion (thinking of Henningfield, Talbot, Glantz, Hahn, Cobb... and their likes).
Etter concludes “If users say that e-cigarettes help them to quit smoking, counsellors should focus on smoking cessation rather than on e-cigarette cessation. Advising smokers to stop using e-cigarettes might be deleterious in many situations, in particular in people who failed to quit with other treatments.”
Now contrast this with Cobb & Abrams’ comment on Wagener et al. (the latter were attacking Cobb’s uninspired anti-ecig papers).

 

[Vocalek]

And let's not forget Peter Hajek's comment.

The general approach to EC at the moment seems to be dictated by an a priori suspicion that they are bad. Wagener et al. show that the main objections to EC generated so far are largely spurious. Others can be added to the list. I have heard it argued that if EC are not regulated, some smokers may purchase brands which deliver little nicotine or deliver it inconsistently. No regulation is needed on how much caffeine different brands of teabags must deliver (the drug content is not even marked), or how tasty and consistent in taste a chocolate bar has to be, or how entertaining a film must be. Consumer products which are not very good will leave a few purchasers disappointed, this is true, but such products will not stay on the market for long, and their failure becomes a valuable benchmark for everyone else.

Commentary on Wagener et al. (2012): E-cigarettes: a vulnerable promise - HAJEK - 2012 - Addiction - Wiley Online Library

 

[Vocalek]

And the thing that struck me about Cobb & Abrams' commentary was this:

Readers not familiar with our position might be surprised that we believe that refined nicotine has a substantial role to play in harm reduction and, like NRT, ‘e-cigarettes’ can in all likelihood be constructed and manufactured in a safe manner. Where we differ is on the specific question of whether a subset of nicotine products should remain on the market exempt from oversight, or if they should be withdrawn pending their regulation.

Commentary on Wagener et al. (2012): Laissez-faire regulation: turning back the clock on the Food and Drug Administration and public health - Cobb - 2012 - Addiction - Wiley Online Library

[SARCASM ALERT] Oh by all means, Mr. Cobb and Mr. Abram, these products should definitely be withdrawn from the market where they will languish for decades, trying to get past the billions of dollars worth of unnecessary, time-wasting testing that the FDA has proposed for the approval process of a modified risk tobacco product. Meanwhile, the smokers who might have been able to substitute them for their cancer-sticks will continue to accrue lung damage, cardiovascular damage, and cellular destruction leading to cancer. Great plan!

Now that I have been abstinent from smoking for over 3 years, should I relapse back to smoking, through some heretofore unknown magical process, smoke will not inflict any more damage on my body. I sure hope that Cobb & Abram are applying for a patent on this magical process.

[/SARCASM ALERT]

Cobb & Abram also seem to have overlooked the part of the tobacco act that prohibits the FDA from banning an entire class of tobacco products.

‘(3) LIMITATION ON POWER GRANTED TO THE FOOD AND DRUG ADMINISTRATION- Because of the importance of a decision of the Secretary to issue a regulation--

‘(A) banning all cigarettes, all smokeless tobacco products, all little cigars, all cigars other than little cigars, all pipe tobacco, or all roll-your-own tobacco products; or

‘(B) requiring the reduction of nicotine yields of a tobacco product to zero,

the Secretary is prohibited from taking such actions under this Act.

SEC. 907. TOBACCO PRODUCT STANDARDS.

True, e-cigarettes are not mentioned in paragraph (A) because e-cigarettes are not covered at all under the tobacco act until the FDA proposes and then enacts a deeming regulation to include them. I see no reason why any additional products deemed in the future to be covered under the Act should be exempt from the prohibition cited above.

 

[kristin]

This is one of the authors, Dr. Siegel, discussing parts of the article: http://tobaccoanalysis.blogspot.com/2012/04/commentary-in-addiction-urges-more.html

 

[Vocalek]

More on the commentary from Etter:

Older models were often of mediocre quality, but these products evolve rapidly and newer models are much more effective: compare the e-cigarette industry with the pharmaceutical industry, which has not marketed any new nicotine medication for a decade. The nicotine inhaler is the same today as it was 2 decades ago, when it was first launched; it is unattractive and requires a hard draw and many puffs to obtain nicotine [6]. In contrast, the e-cigarette industry is much more innovative and reactive, it regularly launches new products and is able to segment the market (e.g. brands for women). Additional technological innovations are needed, in particular to vapourize nicotine directly, without propylene glycol or glycerol. The e-cigarette industry would almost certainly be less innovative if it was regulated, but regulation is nevertheless needed to ensure that these products are safe and effective [7].

I appreciate his recognition that e-cigarettes are evolving products and superior to the pharmaceutical nicotine inhaler. I disagree with his assessment that the e-cigarette industry would be less innovative if it was regulated. The danger lies in the possibility of it being not at all innovative due to regulatory strangulation.

He states that regulation is "needed to ensure that these products are safe and effective." It seems that many scientists are having trouble wrapping their heads around the concept of regulating a "smoking replacement product" (SRP) as opposed to regulating a treatment for a disease. Is there any other tobacco product that will be regulated to ensure that it is "effective"?

Given that the measure of effectiveness of an SRP is whether consumers find it to be an acceptable substitute for smoking, consumers are in a much better position to judge effectiveness than scientists. Products that are not effective will be purchased less often than those that are, and eventually this type of consumer regulation will drive the ineffective products off the market.

Regulators should, instead, focus their efforts on ensuring safety of the products. Common sense regulation of liquids to protect consumers would follow the lead of consumer product safety requirements. These might include testing to ensure there is no contamination, labeling that accurately specifies the contents and the nicotine strength, and poison warnings. Batteries should meet the safety standards already in place for batteries used in other appliances.

Before the FDA implements any regulations called for by the ANTZ such as prohibition of any flavor other than "used ashtray" or an excessively high top limit on nicotine strength, the FDA should demand that the group that wants that regulation present scientific proof of the need for such regulation. The CTFK, ALA, AHA, ACS, etc. would need to present scientific proof that at least 1% of the consumers that used the product in its current formulation have been harmed as a direct result of this "design flaw" or peer-reviewed scientific proof that the current design has caused measurable harm to non-users.

For example, there has been speculation that pleasant flavors will attract youth who are non-smokers to become addicted to nicotine. Yet the only available research on this subject shows that the "abuse liability" of e-cigarettes is very low.

Vansickel AR, Weaver MF, Eissenberg T. Clinical laboratory assessment of the abuse liability of an electronic cigarette. Addiction. 2012 Jan 9. Clinical laboratory assessment of the abuse liabil... [Addiction. 2012] - PubMed - NCBI

There is even further speculation that non-smoking youth who take up use of an e-cigarette will abandon the pleasant flavors to take up the practice of inhaling nasty-tasting smoke. There is not one verified case of this happening in all the years e-cigarettes have been on the market. On the other hand, many former smokers who now use an e-cigarette report that switching to a more pleasant flavor has extinguished all remaining compulsions to light up a real cigarette.

The groups demanding such types of regulation would also need to present scientific evidence that implementing the regulation they want enacted will not negatively impact the acceptability of the products as an SRP for more than 5% of users and potential users.

 

[Screwbag]

I'm amazed at how vilified ecigs have become already in some people minds...risk and danger are so relative and subjective...Let just say for argument sake, that I did subscribe to the notion that ecigs are bad for you...There's ecoli in my burgers.There's lead and worse in my drinking water.There's salmonella in my chicken and eggs.There's countless chemicals that I breath from machines, busses, cars.There's radiation from every direction.There's mercury in my fish.There's poison on and in my fruit and vegetables.And countless others....ALL APPROVED AND SAFE!You think I'm gonna worry about a product whose worst concern might be a bit of a dry throat?

 

[Screwbag]

Another SAFE product category...

Artificial sweeteners....holy hell! and they push diet sodas like crazy cuz its made cheaper when they don't use real sugar...Aspartame give me migraine like headaches...so yet again I'll vape instead of drinking diet sodas...

Ok I'll stop now before I really go on a rant....hahaha

 

[kristin]

I'm amazed at how vilified ecigs have become already in some people minds...risk and danger are so relative and subjective...Let just say for argument sake, that I did subscribe to the notion that ecigs are bad for you...There's ecoli in my burgers.There's lead and worse in my drinking water.There's salmonella in my chicken and eggs.There's countless chemicals that I breath from machines, busses, cars.There's radiation from every direction.There's mercury in my fish.There's poison on and in my fruit and vegetables.And countless others....ALL APPROVED AND SAFE!You think I'm gonna worry about a product whose worst concern might be a bit of a dry throat?

Don't forget that peanut butter, shrimp, eggs, milk and soy can be deadly without any contaminants at all, too. They claim food allergies kill up to 200 people in the U.S. every year. (Of course, lawn mowing kills even more people than food allergies.)

 

[DC2]

And how many people has nicotine killed? If I'm not mistaken, the answer is one.

 

[Petrodus]

Don't forget that peanut butter, shrimp, eggs, milk and soy can be deadly without any contaminants at all, too. They claim food allergies kill up to 200 people in the U.S. every year. (Of course, lawn mowing kills even more people than food allergies.)

YIKES !!! Peanut butter ...
King County, Washington ... might ban peanut butter
"Save the Children"

On the other hand ... King County has no issues at all
with hosting the annual Hemp Fest


Sorry ... I still see red every time I think of
the King County fiasco

 

[Tom09]

Wagener et al. REPLY to comments on the Wagener et al. 2012 discussion paper published (free access):
LET'S KEEP OUR 'EYE ON THE BALL': REDUCING TOBACCO-RELATED HARM - WAGENER - 2012 - Addiction - Wiley Online Library

 

[DC2]

Wagener et al. REPLY to comments on the Wagener et al. 2012 discussion paper published (free access):
LET'S KEEP OUR 'EYE ON THE BALL': REDUCING TOBACCO-RELATED HARM - WAGENER - 2012 - Addiction - Wiley Online Library

Very good reply by the good doctors.