E-Cig Feature in US Parmacist (7/2011)

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Tom09

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MA Weinberg & SL Segelnick: A Profile of Electronic Cigarettes. US Pharm. 2011;36, 37-41.

concluding paragraph:
Based on a literature review and limited clinical studies of ENDS, there seems to be a need for better regulation of these devices. It is far too easy to obtain ENDS on the Internet, not knowing exactly how they function and their harmful effects on humans. Many believe that these devices have significant concerns to the public health community. There is no regulation regarding a standardization of manufacturing of ENDS, including the design of the device and type and dosage of ingredients. Overall, more needs to be known about the possible health benefits and risks before pharmacists can recommend the use of e-cigarettes.
 
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Eddie.Willers

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Pah! More scaremongering!

That conclusion is the very worst kind of speciousness - saying nothing but implying everything.
"not knowing exactly how they function" - it's not rocket science, people! It's a piece of heated wire!
"Many believe that these devices..." - who, exactly are these 'many'?

Clearly, the pharmacists want regulation in the certain hope that they will be called upon to dispense aforementioned, controlled items. As always, follow the $$!
 

GregH

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Overall, more needs to be known about the possible health benefits and risks before pharmacists can recommend the use of e-cigarettes.

Funny...It never even occurred to me to ask my pharmacist's opinion on whether or not I should use an e-cigarette. But if it had occurred to me and I asked the pharmacist "what should I do? continue to smoke or try one of these e-cigarettes?" and the response was continue to smoke, I would find another pharmacy. Because it would be painfully obvious I was talking to an idiot who should not be responsible for filling any of my prescriptions.
 

36tinybells

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I liked this bit:
"Additionally, e-cigarettes may help to suppress the craving to smoke. A clinical study found that after abstaining from smoking overnight, individuals had a decreased desire to smoke with the use of e-cigarettes (16 mg) when compared to conventional cigarettes, but there was no difference when compared to a nicotine inhaler.19 "

Well, okay, if you want to call dropping a 30+ year habit a decreased desire to smoke then I guess I can call him a world class underestimator!
And BTW, I call my vaporizers PV's, not e-cigs, cause a wooden juice box mod has little in common with a paper tube of tobacco!
 

Vocalek

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Email sent to rdavidson@uspharmacist.com and uspeditorial@jobson.com:

A Profile of Electronic Cigarettes, by Weinberg and Segelnick (US Pharm. 2011;36(7):37-41) is missing some critical information. Table 2 lists “Common Adverse Effects of E-Cigarettes.” The rest of the story is that these minor effects are quite similar to the adverse effects seen with use of pharmaceutical nicotine products. The authors fail to note that the products have been in use world-wide since 2004 with no serious adverse events reported. To present a report that is fair and balanced, the article needs to include a table listing the beneficial effects of using E-Cigarettes. Also, including a table listing the characteristics of E-cigarette consumers would help to explain the target market for the products (older folks who have smoked for decades and tried repeatedly to quit without success—until switching to the E-cigarette as a reduced risk alternative to smoking.)

Some of this information is available in two of the references cited by the authors (18 and 19). Three additional references are provided below, with numbering continued from the author’s references list.

Table 3: Common Beneficial Effects of E-Cigarettes

31% to 79% of users stop smoking tobacco cigarettes. (30, 31, 32)
An additional 17% to 66% report a large reduction in smoking (30, 31, 32)
Dual users who smoke the same amount comprise only 3% to 4% (30, 31)
49% of switchers reduce their nicotine intake (30)
97% report their health has improved (31)
Relief of craving to smoke (19, 32)
>80% report relief of restlessness, anger, and anxiety (32)
>70% report relief of difficulty concentrating and depressed mood (32)
79% use e-cigarettes to avoid relapse to smoking (32)
No increase in heart rate, blood pressure, or CO levels (18, 19)

Table 4. E-Cigarette User Profile

About half are between ages 31 and 50 (31, 32)
One-third are older than 50 (31, 32)
All previously smoked (31, 32)
86% previously failed to quit by using pharmaceutical products (31)
21% had tried previously to quit 10 or more times (31)

30. Siegel MB, Tanwar KL, Wood KS. Electronic cigarettes as smoking cessation tool: Results from an Online Survey. American Journal of Preventive Medicine 2011 Apr; 40(4):472-5. http://www.ajpm-online.net/webfiles/images/journals/amepre/AMEPRE3013.pdf (accessed July 2011)
31. Heavner K, Dunworth J, Bergen P, Nissen C, Phillips CV. Electronic cigarettes (e-cigarettes) as potential tobacco harm reduction products: Results of an online survey of e-cigarette users. Tobacco Harm Reduction 2010: a yearbook of recent research and analysis. A production of TobaccoHarmReduction.org. http://tobaccoharmreduction.org/wpapers/011v1.pdf (accessed July 2011)
32. Etter JF, Bullen C. Electronic cigarette : users profile, utilization, satisfaction and perceived efficacy. Addiction 2011 DOI: 10.1111/j.1360-0443.2011.03505.x. Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy - Etter - 2011 - Addiction - Wiley Online Library
 
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illillillillilli

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Wait did I read this right?
Questions have arisen as to what health effects e-cigarettes have on an individual. Certain clinical parameters have to be evaluated in e-cigarette users versus conventional smokers. Such parameters include the plasma nicotine levels, cardiovascular response (heart rate), periodontal disease involvement, and oral cancer incidence. It is well established that nicotine and its by-products in conventional cigarettes cause or increase the incidence of oral/head and neck cancers and periodontal diseases, and show nicotine present in the plasma.17 Additionally, e-cigarettes should not be used by pregnant women because of the nicotine. In contrast to regular cigarettes, e-cigarettes have not been found to be a risk factor for lung cancer or stroke. Although one clinical study in 2010 did not find any increase in heart rate or measurable levels of nicotine in the plasma, there are still not enough studies to show a complete profile of acute or chronic effects of e-cigarettes.
Oral cancer? How?! Neck cancer? How? I thought it was already said that there were no carcinogens? Are additional studies really necessary? E-cigs still have less ingredients than analogs, correct? A few vs. many(analogs). For the addicted smoker which would seem like the better option: keep smoking analogs, nic replacement gum or patches, cold turkey, or an e-cig? hmmm. Tough one. Isn't there a drug out there supposed to help with nic cravings? The same drug that can cause cardiovascular problems and stroke? Puh-leaze.
 

hairball

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I went to Walgreens a couple months ago in search of a few BD 3ml syringes. I love the pharmacist there. She's a blast. Spike haircut, has a really cool tattoo on her back of her daughter (not big), and loves telling jokes. I casually asked her for a couple without needles. She looked at me funny and out of curiosity asked why I would want them without a needle. I told her I needed them to mod a couple of cartomizers for my ecig or another term, PV. She got a big smile and asked what type of carto I was using. My eyes widened a tad...I said a clear dual coil. She asked what type of PV I used with them. Not really dumbfounded but taken off guard, I said a Prodigy V3.1....she pulled her black Buzz out. We talked for 2 hours.

This report shows total ignorance as usual.
 

moonlessnight

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I went to Walgreens a couple months ago in search of a few BD 3ml syringes. I love the pharmacist there. She's a blast. Spike haircut, has a really cool tattoo on her back of her daughter (not big), and loves telling jokes. I casually asked her for a couple without needles. She looked at me funny and out of curiosity asked why I would want them without a needle. I told her I needed them to mod a couple of cartomizers for my ecig or another term, PV. She got a big smile and asked what type of carto I was using. My eyes widened a tad...I said a clear dual coil. She asked what type of PV I used with them. Not really dumbfounded but taken off guard, I said a Prodigy V3.1....she pulled her black Buzz out. We talked for 2 hours.



This report shows total ignorance as usual.

I love it that is just awesome!
 

JW50

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Pah! More scaremongering!

That conclusion is the very worst kind of speciousness - saying nothing but implying everything.
"not knowing exactly how they function" - it's not rocket science, people! It's a piece of heated wire!
"Many believe that these devices..." - who, exactly are these 'many'?

Clearly, the pharmacists want regulation in the certain hope that they will be called upon to dispense aforementioned, controlled items. As always, follow the $$!

+1 here. There should be a regulation for those that propose regulation. Like Environmental Impact Studies - Regulation Impact Studies and always pass the do nothing option before proposing.

"more needs to be known about the possible health benefits and risks before pharmacists can recommend the use of e-cigarettes" - Your recommendation is not wanted unless you wish to get off your .... and do some research.
 

Pandy

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I did a test run to the Pharmacists down at walmart! I walked up and asked, "You know what this is," holding my pv in one hand, other one point towards it.

The fine lady behind the counter responsed, "That's a e-cigarette. Why?"

"Is there any policy to recommend these to anyone." I questioned.

"No, you should try the patches or gum. Personally..." in a more quieter voice, "I got one myself, best thing that worked."

I just busted up laughing. I told her about the US Pharmacists article and he first words out of her mouth after that was, "Who the hell is US Pharmacists?" I guess they don't get that many readers who are actually Pharmacists.
 

Vocalek

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Wait did I read this right?

Oral cancer? How?! Neck cancer? How? I thought it was already said that there were no carcinogens? Are additional studies really necessary? E-cigs still have less ingredients than analogs, correct? A few vs. many(analogs). For the addicted smoker which would seem like the better option: keep smoking analogs, nic replacement gum or patches, cold turkey, or an e-cig? hmmm. Tough one. Isn't there a drug out there supposed to help with nic cravings? The same drug that can cause cardiovascular problems and stroke? Puh-leaze.

Your post prompted me to write a follow-up email comment:

I wrote to you yesterday regarding A Profile of Electronic Cigarettes, by Weinberg and Segelnick, US Pharm. 2011;36(7):37-41. A careful re-reading of the article revealed some additional problems.

It is well established that nicotine and its by-products in conventional cigarettes cause or increase the incidence of oral/head and neck cancers and periodontal diseases.

The above statement contains two assertions that are not supported by the scientific evidence. Neal Benowitz, one of the world’s leading experts on nicotine safety and toxicity, testified at an FDA public hearing last fall. One of his slides contained the following bullet item: “No evidence that nicotine causes or promotes cancer.” SOURCE: Benowitz, NL. Smokeless Tobacco and Disease: Evidence Related to Long-term Safety of Nicotine. Presentation at FDA Public Workshop: Risks and Benefits of Long-Term Use of Nicotine Replacement Therapy (NRT) Products. October 26, 2010. His presentation can be downloaded here: http://www.fda.gov/downloads/Drugs/NewsEvents/UCM232147.pdf

Also, don’t believe all the government warning labels on smokeless products. The warning about tooth loss and gum disease were written based on one study that failed to stratify or make a risk adjustment based on socioeconomic status. It is quite likely that the higher rate of dental problems seen in that group was due to poor dental hygiene and lack of professional dental care. Swedish investigators have just published a study in the Journal of Clinical Periodontology documenting “no significant association between gingivitis, [periodontal pockets] and periodontal disease experience and snus use.” (abstract Periodontal disease in relation to smoking and the... [J Clin Periodontol. 2011] - PubMed result.

Periodontal disease rates are highest among cigarette smokers, as are cancer rates.

The writers do, understand, do they not, that e-cigarettes are not a nicotine-weaning medication? The vast majority of e-cigarette users are smokers who, despite repeated attempts, have not been able to stop using nicotine. E-cigarettes serve as an alternative source of nicotine, with many of the health hazards of cigarette smoke removed. Exposure to most carcinogens is eliminated, and the daily exposure to Tobacco Specific Nitrosamines is reduced by a factor of nearly 16,000.


Hazardous Substance Tobacco Smoke E-Cigarette Vapor
Tar Yes No
Carbon Monoxide Yes No
Particulates Yes No
Chemicals of combustion Yes No
Heavy metals Yes No
Tobacco-Specific Nitrosamines* 127,000 ng / day 8 ng / day
Nicotine* 28-48 mg / day 14-16 mg / day

* Laugesen, M. Second Safety Report on the Ruyan E-Cigarette, Health New Zealan d. http://www.healthnz.co.nz/2ndSafetyReport_9Apr08.pdf

I emphasize once more that e-cigarette consumers are, for the most part, smokers who would NOT have been able to quit. If the only two choices you are given are 1) keep smoking 2) switch to e-cigarettes, which would you recommend for someone you love?

I'm keeping my fingers crossed that the data that looked very spiffy inside of an MS Outlook Table keeps its spacing when I store this message.
 

Pamdane

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So, anybody want to check grammer and spelling before I send this?

Dear Sirs/Madams,

I have recently had exposure to the recently released material noted on subject line.
I am extremely disappointed in the lack of professional presentation and information written in the publication.

I specifically refer to this excerpt:

"Based on a literature review and limited clinical studies of ENDS, there seems to be a need for better regulation of these devices. It is far too easy to obtain ENDS on the Internet, not knowing exactly how they function and their harmful effects on humans. Many believe that these devices have significant concerns to the public health community. There is no regulation regarding a standardization of manufacturing of ENDS, including the design of the device and type and dosage of ingredients. Overall, more needs to be known about the possible health benefits and risks before pharmacists can recommend the use of e-cigarettes."

The personal vaporizers referenced above have been on the market for 8 years. This is more than adequate time to determine efficacy. It is also time enough to determine that the devices have had no reported negative effects on health. There is a standardization. Research would have determined this. The devices are manufactured by companies which in some cases manufacture parts for pharmaceutical devices. Devices have pre measured capacities. The content of the capacities is determined by the end user. I can only compare these to Asthma inhalers. They use the same Propolene glycol base, and what is inhaled is at the control of the person inhaling. The end user provides the liquid to fill these devices. As with any vaporizer, what is put into them is out of manufacturer control. The "personal" vaporizer is no different than the "household" vaporizer sold at pharmacies world wide. The only difference is size and method of powering the devices. Due to its smaller sizer, the personal vaporizer is run on batteries. The personal vaporizer is an electronic device, pure and simple. Just as a nebulizer is. It is the liquid that is in question, not the device.
I look forward to seeing a more informative article in your publication, noting the ambiguous references in this article have been revised and more investigation into the matter was done by "more knowledgable" sources. You have the opportunity to be on the cutting edge of medical technology. The personal vaporizer has so many potential medical uses, I would expect the medical industy and pharmicies to embrace it. Imagine not having to fight a toddler to use a mask to inhale vapors? ALL of the fluid is utilized, there is no loss such as seen through mask vents. A smoking cessation tool it may be, true research shows that it is, but these are un-funded research works, composed by individuals with nothing to gain. The type of publication seen here could be used very effectively, if anyone where interested in doing so. Please, get the truth out, not unfounded suspicions from people afraid to speak out.
I suspect the article is a futile attempt to get the FDA involved in the regulation of electronic devices. Fortunately for us, US citizens have federal courts seeing to our rights. Perhaps pointing the finger at the true culprit- Nicotine, would be more appropriate. Fortunately for all involved, the cigarette industry will not allow this. But that wil not stop them from trying to blow smoke(pun intended).

Thank you,

Pam Briggs
 

Bill Godshall

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vocalek wrote:

Also, don’t believe all the government warning labels on smokeless products. The warning about tooth loss and gum disease were written based on one study that failed to stratify or make a risk adjustment based on socioeconomic status. It is quite likely that the higher rate of dental problems seen in that group was due to poor dental hygiene and lack of professional dental care.

Where did you hear/read that, and what study are you referring to?

For nearly a decade, I've been searching for studies that found an association between smokeless tobacco usage and tooth loss or gum disease, and I haven't been able to find any studies.

But I do know that back in 1985/1986, Greg Connolly (who demonized dissolvables at last week's TPSAC meeting) was working behind the scenes on the US Surgeon General Report that grossly exaggerated the health risks of smokeless tobacco, and the resulting 1986 Comprehensive Smokeless Tobacco Education Act (which mandated the three inaccurate/misleading warnings on smokeless tobacco products).

Connolly also was instrumental in scaring and lobbing the EU, Australia, NZ and Hong Kong to ban the sale of snus during the past two decades.
 

Vocalek

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vocalek wrote:



Where did you hear/read that, and what study are you referring to?

For nearly a decade, I've been searching for studies that found an association between smokeless tobacco usage and tooth loss or gum disease, and I haven't been able to find any studies.

But I do know that back in 1985/1986, Greg Connolly (who demonized dissolvables at last week's TPSAC meeting) was working behind the scenes on the US Surgeon General Report that grossly exaggerated the health risks of smokeless tobacco, and the resulting 1986 Comprehensive Smokeless Tobacco Education Act (which mandated the three inaccurate/misleading warnings on smokeless tobacco products).

Connolly also was instrumental in scaring and lobbing the EU, Australia, NZ and Hong Kong to ban the sale of snus during the past two decades.

SMOKELESS TOBACCO AND PERIODONTAL DISEASE

Fisher et al.(2005) claim to have published the first report of an association between smokeless tobacco (SLT) use and periodontal disease, based on odds ratios of about 2 that are only marginally statistically significant. However, their analysis is deficient. They did not control the reported association for education and socio-economic status (SES), two of the strongest correlates of periodontal disease that are also strongly and inversely correlated with SLT use. It is a certainty that control for education and SES will reduce the odds ratios and render them non-significant.

I was thinking that it was an old study. But I knew I had read somewhere that there was a study that showed an association, but was criticized for not controlling for SES. So I went looking and tracked it down. Turns out that it was only 6 years ago and it was our good friend, Dr. Brad Rodu who pointed out the shortcomings of the study.
 
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