Electronic cigarettes: miracle or menace?
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c311 (Published 20 January 2010) Cite this as: BMJ 2010;340:c311
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The authors call for ‘extensive research involving animal studies’. How are these are supposed to provide useful information about the safety, or otherwise, of electronic cigarettes in humans? Suppose such studies show no toxic effects in animals. Would this mean, then, that electronic cigarettes are safe for humans? On the other hand, if they produce harmful effects, would this mean that electronic cigarettes are unsafe for humans?
In other words, what is the scientific basis for believing that the results of studies in animals can be extrapolated to humans?
I submit there is none, and the results of these experiments will be no better than guess-work.Competing interests:
None declared
Competing interests: No competing interests
« Vaporising nicotine and other chemicals into an inhalable vapour »
[1] is nothing new. This is actually what the harm reduction Eclipse
cigarette (RJ Reynolds) and the modern hookah (shisha, narghile) are
doing. Indeed, their principle is the same [2-4]. In these conditions, we
may assume that the Chinese E-cigarette companies drew their inspiration
from the growing world popularity of hookah smoking.
However, the main humectant in Eclipse and shisha is not propylene
glycol as with E-cigarettes but glycerol. In both cases, tobacco or the
flavoured tobacco-molasses mixture, is heated and not burnt as in regular
cigarettes [4]. Researchers early noted that glycerol is harmless, easily
absorbed, and metabolised as a source of energy [3].
Finally, it is worth noting that an electronic Hookah, the E-Hookah,
has now been launched. However, when contemplating all the biomedical and
anthropological aspects of hookah smoking, It is not sure that this gadget
will enjoy the same success as the other E-products. First, and notably,
hookah has not posed any particular over the past centuries (sort of
prehistoric harm reduction technique). Second, it is not or little
addictive (and is another concrete example that «nicotine addiction» is an
erroneous dogma). Third, hookahs generate almost no side-stream smoke.
Fourth, and not lastly, most users are convinced that the traditional
preparation of a hookah is an important element of its social spell [4].
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REFERENCES :
[1] Flouris AD, Oikonomou DN. Electronic cigarettes: miracle or
menace ? BMJ. 2010 Jan 19;340:c311. doi: 10.1136/bmj.c311.
[2] Eclipse Expert Panel. A safer cigarette? A comparative study. A
consensus report. Inhal. Toxicol. 2000;12:1–58.
[3] Sutherland G, Russell MA, Stapleton JA, Feyerabend C. Glycerol
particle cigarettes: a less harmful option for chronic smokers. Thorax
1993;48:385–387.
[4] Chaouachi K. Hookah (Shisha, Narghile) Smoking and Environmental
Tobacco Smoke (ETS). A Critical Review of the Relevant Literature and the
Public Health Consequences. Int. J. Environ. Res. Public Health 2009;
6(2):798-843. doi:10.3390/ijerph6020798
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid...
________________________________
Competing interests:
No competing interests. For more details, see the corresponding section at Reference 4
Competing interests: No competing interests
The FDA failed to report the results of a quantitative analysis and
to use the appropriate control--tobacco cigarettes. Had this information
been provided, it would have been obvious that the liquid in e-cigarette
cartridges poses approximately the same level of danger as FDA-approved
nicotine products and is thousands of times safer than smoking tobacco
cigarettes.
Last June, FDA called on consumers to report adverse events involving
e-cigarettes to its MedWatch surveillance program. Apparently, no
problems were reported. U.S. District Court Judge Richard Leon, in ruling
against the agency stated, “FDA cites no evidence that those electronic
cigarettes have endangered anyone.
In the absence of compelling evidence of actual or anticipated harm,
it is irresponsible for anyone concerned with public health to advise,
“Just keep smoking until we are sure this alternative is 100% safe.” It
is even more irresponsible to tell former smokers to stop using the
product that keeps them from going back to deadly tobacco smoke.
Competing interests:
None declared
Competing interests: No competing interests
Flouris and Oikonomou lament the lack of data on e-cigarette
risks.[1] Apart from our 2008 poster cited [1], our further reports [2, 3]
and extensive emissions data we gathered in 2009 show complete absence of
most priority cigarette toxicants in e-cigarette liquid and mist. However,
we only tested one brand (Ruyan, Beijing). And, as Flouris and Oikonomou
point out, quality safeguards in manufacture are essential.
Even if testing showed all e-brands were less toxic than cigarettes,
consumer safety requires quality control at site of manufacture, and
monitoring to minimise the risk of adulteration. In 1990, propylene
glycol, now used to create the mist in e-cigarettes, was adulterated by
toxic diethylene glycol (DEG) with tragic results. As recently as 2007, US
FDA found DEG in Chinese toothpaste at 3%,[4] and found DEG at 1% level
in 2009 in one e-cigarette brand.[5] E-cigarettes need regulation imposed
to safeguard their quality, so they can continue to provide an alternative
to cigarette smoking.
Murray Laugesen,
Public health physician,
Health New Zealand Ltd.
www.healthnz.co.nz
1. Flouris AD, Dimitris N Oikonomou DN. Electronic cigarettes:
miracle or menace? Letter. BMJ 2010;340:c311
2. Laugesen M. Safety report on Ruyan e-cigarette and cartridge. 30
October 2009. http://www.healthnz.co.nz/RuyanCartridgeReport30-Oct-08.pdf
3. Laugesen M. Ruyan e-cigarette bench-top tests. Poster. Society for
Research on Nicotine and Tobacco. Dublin April 2009.
laugesen@healthnz.co.nz/DublinEcigBenchtopHandout.pdf
4. Throw away Chinese toothpaste, FDA warns. Products may contain
poisonous chemical used in antifreeze. Associated Press 1 June 2007.
http://www.msnbc.msn.com/id/18985512/
5. Westenberger BJ. Evaluation of e-cigarettes. Center for Drug
Evaluation and Research, Division of Pharmaceutical Analysis, St Louis,
MO. US Food and Drug Administration. 2009.
Competing interests:
Research contract with Ruyan during 2008, but no financial interest in Ruyan.
Competing interests: No competing interests
Re: Electronic cigarettes: miracle or menace?
It is all but impossible to remove Tobacco-specific N-nitrosamines completely from nicotine extracted from tobacco.
1)The article failed to mention that the other NRT products (gum, patches and inhalers) have the same level of TSNAs as e-cigarettes.
2)It also failed to say that the New Zealand study concluded that carcinogens and toxicants in ecigarettes were present only below harmful levels. (There are carcinogens and toxicants at similar levels in virtually every meal we eat.)
Many e-cig users think that an author mentioning TSNAs without including these two facts is setting out to deceive readers into thinking e-cigs have hidden dangers.
Doctors have their work cut out trying to keep up with medical developments without such a misleading article. Doctors should be aware that smokers are able to give up cigarettes without much willpower by using e-cigarettes. And that the cigarette lookalikes are nowhere near as effective as the refillables.
Competing interests: No competing interests