Interest in E-cigarettes Is High, but Safety and Effectiveness Unknown [Health Behavior News]

[Placebo Effect]

Health Behavior News Service - Research News Archives

Interest in E-cigarettes Is High, but Safety and Effectiveness Unknown
By Milly Dawson, Contributing Writer
Research Source: American Journal of Preventive Medicine
Health Behavior News Service

Electronic cigarettes are drawing heavy media and marketing attention, and while a new study finds that consumer interest also runs high, a companion study underscores that e-cigarettes’ ability to help smokers cut down or quit is unknown.

E-cigarettes run on batteries and look like real cigarettes, cigars or even ballpoint pens. Users inhale doses of nicotine or other toxins found in tobacco in vapor form. Because e-cigarettes do not contain tobacco or create smoke, manufacturers are marketing them both as a safer alternative to smoking and as a cessation aid.

Of the two studies appearing online and in the April issue American Journal of Preventive Medicine, one shows that consumer interest in e-cigarettes currently is much higher than interest in more traditional products.

“Although we don’t know much about the health effects of e-cigarettes, they are by far the most popular smoking alternatives and cessation products on the market,” said lead author John Ayers, a doctoral candidate at Johns Hopkins Bloomberg School of Public Health.

His group monitored English-language Google searches in the USA, Canada, the UK and Australia from January 2008 until September 2010. They compared searches for e-cigarettes with searches for a nicotine lozenge and for cessation products like nicotine patches, nicotine gum and the drug Chantix (varenicline).

Between July 2008 and February 2010, searches about e-cigarettes increased sharply in all nations, especially in the United States. “We found that e-cigarettes were more popular in U.S. states with stronger tobacco control,” Ayers said. This, he said, suggests that consumers are using e-cigarettes to either bypass smoking restrictions or to quit when faced with restrictions.

To see if searches on e-cigarettes led to sales, his group monitored online shopping searches. Shopping search trends mirrored informational search trends, they found.

In the second study, Michael Siegel, M.D., looked at e-cigarettes’ effectiveness as smoking cessation aids using an online survey. Siegel, a professor at the Boston University School of Public Health, obtained 5,000 email addresses of people who had made a first-time purchase in 2009 from an e-cigarette distributor.

Of the 222 consumers replied to the survey, 216 were qualified to participate. Nearly 67 percent of these respondents said they reduced the number of cigarettes they smoked since using e-cigarettes and 49 percent reported that they had quit smoking for an unspecified time after trying e-cigarettes.

Siegel acknowledged and other smoking cessation experts have said that it is possible that smokers who had greater success cutting down or quitting were more likely to respond. This would bias the results, which already relied on a small fraction of those contacted.

“We don’t know anything about the 95 percent of the people who deleted the email,” said Jennifer Unger, Ph.D. “Maybe they’re still smoking the same number of cigarettes. Maybe they are using even more nicotine than before because they’re smoking ordinary cigarettes and e-cigarettes.” Unger, with the Institute for Health Promotion and Disease Prevention Research at the University of Southern California, has no affiliation with either study.

“Neither of these two studies provides scientific evidence that e-cigarettes are effective in helping people to quit,” said John Pierce, Ph.D., a professor of cancer prevention at the Moores Cancer Center at the University of California at San Diego. “It’s not clear to me that e-cigarettes aren’t harmful in some way. It’s not clear to the FDA, either.”

In Sept. 2010, the Food and Drug Administration cited five e-cigarette distributors for “unsubstantiated claims and poor manufacturing practices,” according to an agency release. In January 2011, the FDA moved unsuccessfully to block e-cigarette importation.

I bolded what I did because of the ridiculous of the author asserting that the safety risks are unknown, but writing about a future study by Dr. Michael Siegel, who just 45 days or so ago released his compilation of the studies on the safety of the e-cigarette.

 

[kristin]

"Maybe they are using even more nicotine than before because they’re smoking ordinary cigarettes and e-cigarettes.”

I don't get the assertion that the nicotine use could be HIGHER. If they are substituting e-cigarette use where they would normally smoke a cigarette, how does that increase their nicotine intake? It's like saying people who eat strawberry ice cream sometimes AND chocolate ice cream other times are somehow increasing their fat intake rather than if they ate only chocolate all of the time?? How does that even make sense?

 

[Placebo Effect]

I don't get the assertion that the nicotine use could be HIGHER. If they are substituting e-cigarette use where they would normally smoke a cigarette, how does that increase their nicotine intake? It's like saying people who eat strawberry ice cream sometimes AND chocolate ice cream other times are somehow increasing their fat intake rather than if they ate only chocolate all of the time?? How does that even make sense?

It's the old dual-use argument, which is what the anti-public-health crowd pulls out of their hat whenever a smoking alternative is suggested. In this woman's mind, there are probably slew of e-cigarette users out there who not only smoke the same number of cigarettes as they did before getting the e-cigarette, but then use the e-cigarette at times where, in the past, they weren't allowed to get nicotine in their system due to smoke-free laws.

With your statement, it's the same thing as saying, "Consumers may be buying those boxes of low-fat strawberry ice cream, but we don't know if they're eating the same amount of chocolate ice cream as before, and then getting up for a midnight snack and having the strawberry, thus further endangering their health."

 

[kristin]

I know, but the only reason they would still smoke as much is if they weren't getting sufficient nicotine from the e-cigarette, which again negates the "more nicotine" theory. And the "smoke-free laws cutting nicotine intake" theory doesn't acknowledge people already using gums, lozenges and smokeless tobacco products where they can't smoke.

 

[Placebo Effect]

I know, but the only reason they would still smoke as much is if they weren't getting sufficient nicotine from the e-cigarette, which again negates the "more nicotine" theory. And the "smoke-free laws cutting nicotine intake" theory doesn't acknowledge people already using gums, lozenges and smokeless tobacco products where they can't smoke.

As you know, in these people's minds, the possibility and perceived dangers of dual-use only exist for smokeless tobacco and e-cigarettes. Additionally, they also seem to believe that the human body does not know when it has had enough nicotine, and that cigarette / smokeless users are too stupid to recognize the signals sent by the body instructing the user to stop ingesting it.

 

[kristin]

Yeah, they refuse to acknowledge that the type of mechanism which keeps most people from eating until they throw up is very similar to that which signals "stop" for nicotine users. There is a reason why most people don't smoke 20 packs a day (other than time constraints) either, even though it's supposedly more addictive than crack! By their assessment, we should all be quitting our jobs so we can smoke all day and night.

(PS. I do know the answers - I just post the questions to get vapers reading these threads to think about these things and have ammunition to use later!)

 

[my2heartboys]

In the cases of the gum and/or lozenges, they may actually be getting MORE nicotine than through the patches or ecigs.

Anne

 

[Placebo Effect]

In the cases of the gum and/or lozenges, they may actually be getting MORE nicotine than through the patches or ecigs.

Anne

Not to mention the fact that there are (what appear to be legitimate) concerns about the long-term effects of nicotine gum and lozenges, unlike with e-cigarettes and Swedish snus. 'Cancer risk of nicotine gum and lozenges higher than thought' - Times Online

 

[Thulium]

I find the "dual use" argument darkly hilarious. Are people who drive hybrid vehicles doing more damage to the environment because they use electric AND combustion???

 

[Vocalek]

Not to mention the fact that there are (what appear to be legitimate) concerns about the long-term effects of nicotine gum and lozenges, unlike with e-cigarettes and Swedish snus. 'Cancer risk of nicotine gum and lozenges higher than thought' - Times Online

As usual, the headline of the story leaves out qualifiers such as "might be".

The story is about scientists who were looking at the effects of nicotine on a particular gene mutation found in cancers of the mouth. These were laboratory studies performed at the cellular level, not human trials. This is what is called "basic" research. Although basic research can point the way toward other studies, it doesn't provide proof of anything.

Here is what the scientists said about their study:

The results raise the prospect that nicotine, the addictive chemical in tobacco, may be more carcinogenic than had previously been appreciated. “Although we acknowledge the importance of encouraging people to quit smoking, our research suggests nicotine found in lozenges and chewing gums may increase the risk of mouth cancer,” Dr Teh said. “Smoking is of course far more dangerous, and people who are using nicotine replacement to give up should continue to use it and consult their GPs if they are concerned."

The only way to find out whether long-term use of NRTs actually does increase mouth cancer risk is to track down groups of people who have totally stopped smoking by using NRTs, and divide them into two groups: Those who used NRTs as directed to wean down and off nicotine and those who continue to use NRTs as a long-term substitute for smoking. Compare their rates of mouth cancer, stratifying by age, gender, and number of years smoke-free, length of time NRTs were used, as well as quantity of the NRT products continuing to be used long-term.

They might find that those who used a higher nicotine dose-per-day developed mouth cancer at a higher rate and be able to define the maximum safe dose. They might find that those who used any NRT at all for more than "X" years develop mouth cancer at a higher rate. It is also entirely possible that they might find no difference at all in mouth cancer rates.

 

[Placebo Effect]

Thanks for the clarification Elaine.

 

[Turnkeys]

I have to say that statements like the following tend to make me a little nuts.

Users inhale doses of nicotine or other toxins found in tobacco in vapor form.

"Yes I'm switching from Gormet Vapors in search of another vendor because they do not offer arsenic or benzene instead of nicotine in their e-liquids!"

Milly Dawson, just to be clear, that's a joke.

 

[n2xe]

I reject the notion that the "safety and effectiveness are unknown", it is completely known. I know we are talking about government lawyers and they aren't exactly the best and brightest but nobody goes to court without doing due diligence. So when an entity like the FDA goes to court trying to shut down e- cig suppliers and all they have are insignificant traces of antifreeze and no dead bodies, rest assured that they scoured every hospital bed on earth and found nothing. They have staffers that have spent years reading all the same research we read plus they get to see all the unpublished government research that we don't. If they had anything to make a case, it would be splashed over every news outlet.

They know an awful lot and they are not happy. We e-cig users should take enormous comfort in that.

 

[Zal42]

The story is about scientists who were looking at the effects of nicotine on a particular gene mutation found in cancers of the mouth. These were laboratory studies performed at the cellular level, not human trials. This is what is called "basic" research. Although basic research can point the way toward other studies, it doesn't provide proof of anything.

For a number of years, I worked as a research assistant in a neuroscience lab. I can tell you that the scientists in the building (a couple dozen labs) universally HATED talking to the press -- because the press always always always misreported what they said and ended up implying that the research, whatever research it was, said things that the researchers didn't claim.

The reason is what Vocalek says: reporters report on the implications as if they were fact instead of the speculation that they are. Reporters also tend to bias the reporting to fit a preconceived idea -- which takes it out of the realm of science altogether. Reporters leave out the qualifiers, and don't respect the fact that scientists speak speak precisely and choose their words intentionally. When a scientist says things like "may," "suggests," "might," etc., they mean it. It's another way of saying "this might end up being proven, but right now, it's a guess."

Always take reporting on what a researcher says with a large block of salt. If you want to know what the research really says, read the actual papers.

 

[n2xe]

I've always said that if journalists had an aptitude for science, they'd be scientists, not journalists. Those that can, do, those that can't, teach. Those that can't teach, teach physical education, and those that can't teach phys Ed become journalists.

For a number of years, I worked as a research assistant in a neuroscience lab. I can tell you that the scientists in the building (a couple dozen labs) universally HATED talking to the press -- because the press always always always misreported what they said and ended up implying that the research, whatever research it was, said things that the researchers didn't claim.

The reason is what Vocalek says: reporters report on the implications as if they were fact instead of the speculation that they are. Reporters also tend to bias the reporting to fit a preconceived idea -- which takes it out of the realm of science altogether. Reporters leave out the qualifiers, and don't respect the fact that scientists speak speak precisely and choose their words intentionally. When a scientist says things like "may," "suggests," "might," etc., they mean it. It's another way of saying "this might end up being proven, but right now, it's a guess."

Always take reporting on what a researcher says with a large block of salt. If you want to know what the research really says, read the actual papers.

 

[kristin]

Just as they say "Smokeless tobacco/e-cigarettes are not a safe alternative to smoking," saying "we don't know" is a half-truth. "Not safe" is meant to distract from the fact that it actually is SAFER. With pharmaceuticals, they are perfectly happy to allow for safety risks because the product is SAFER than the alternative. They refuse to give tobacco/e-cigs the same leeway.

There ARE things about e-cigarettes which we do not know WITH 100% CERTAINTY. (They never finish that sentence.) We don't know about inhaling long-term the chemicals in the food flavorings. We DO know that other than diacetyl, there have been no reports of negative health affects by workers who are exposed to breathing in fumes when making or working with artificial flavorings. So, while that is a good indication, there hasn't been a test proving this 100%. Of course, pharma products aren't even held to a 100% certainty standard!

We don't know 100% the long-term consequences of humans inhaling PG to the extent that vapers use it. We can surmise from the testing on rats in the 40's and that PG is used in aerosols and fog machines. But humans aren't rats and most people don't stand in front of a fog machine for 8 hours a day.

We don't know that companies aren't taking shortcuts and using inferior products - such as low quality PG that could be contaminated by DEG or non USP nicotine - because there is no transparency and no one holding them to production standards.

So while there is a lot that we do know about the ingredients (and with vapers acting as guinea pigs for the past 7 years and showing no serious adverse reactions) and that is about the same amount of information gathered for typical pharmaceutical testing submitted to the FDA, because no one has done long-term, peer-reviewed clinical studies on humans, they can claim "we don't know."

What they DON'T tell you as that most pharmaceuticals aren't tested long term either and are based on a small, selective group of subjects. The research for Chantix was paid for by the company who made it. It was tested short-term on a very select group - which specifically excluded those with mental health issues. It was only after it was on the market for a few months and tested on the main population (which has been happening with e-cigarettes for the past 7 years) did they know the negative health risks. Even then, they left it on the market because they decided it was doing more good than harm. I saw a disclaimer on another drug that said "Have not been tested for use beyond 2 years" and it was a product that needed continuous use to work!

So, what the antis are REALLY saying if you finish the sentence is "We don't know....with 100% certainty, if e-cigarettes will stand up to higher standards and stricter criteria than we even hold pharmaceutical products to."

Technically, that's true.

 

[Zal42]

So, what the antis are REALLY saying if you finish the sentence is "We don't know....with 100% certainty, if e-cigarettes will stand up higher standards and stricter criteria than we even hold pharmaceutical products to."

Indeed. This is one of the two arguments the antis make that really drive me bonkers. The personal safety issue isn't whether e-cogs are safe in some absolute sense, it's whether they are safer than smoking. And I feel quite comfortable saying, based on anecdotal evidence + what we actually do know about about safety in a scientific sense, that e-cigs are obviously safer than cigarettes.

The other is how they slyly divert the whole premise away from the second-hand smoke issue. The entire basis of antismoking laws has been to protect people from exposure to second-hand smoke. With e-cigs, there is no such issue, so the antis pretend that it has been about something else all along. Although it reveals their true agendas (a good thing), it really irritates me.

 

[DMF]

I have to say that statements like the following tend to make me a little nuts.



"Yes I'm switching from Gormet Vapors in search of another vendor because they do not offer arsenic or benzene instead of nicotine in their e-liquids!"

Milly Dawson, just to be clear, that's a joke.

Seriously that's the part that caught me first too! Gawd I hate busybody doo-gooders who don't get their facts straight and claim things as gospel without proper research!

::edit::
ACK! ok somehow ...grumble grumble! the part about the "Users inhale doses of nicotine or other toxins found in tobacco in vapor form." is what made me mad.... Just to clarify!

 

[n2xe]

OK, now I'm depressed. I always thought that surely the FDA would come to their senses and accept that reduced risk or low risk (but non-zero risk) would be a desired outcome. But then it dawned on me that the FDA (along with the EPA) regulates pesticides and even with an explosion of bedbugs, they won't release their grip on DDT. With their input, the World Health Organization keeps DDT unavailable and 15 million malaria deaths per year doesn't phase them a bit. There is no risk vs. benefit evaluation.

So why would a few hundred thousand tobacco deaths a year bother them? This does not bode well for smokeless alternatives.

 

[Traver]

By now I would think that most of us understand that what we need to counter is the propaganda, the fear mongering and the ignorance. The facts are on our side.
When they say the FDA found antifreeze it instills fear among the public.
When they say the FDA found carcinogens it has the same affect.
Or the FDA doesn't know if they are safe.
Our problem is to word our arguments in a way that impacts the public and keep getting it out where they can see it.