Friday 26 September 2014

Debunking Canadian Public Health Myths about Electronic Cigarettes





Across Canada municipalities and other jurisdictions are considering banning e-cigarettes. Is this the best thing to do to protect the public? What are the issues, the 
concerns, and what does the research so far tell us about e-cigarettes.


Overall the argument has been that we do not know enough about e-cigarettes and the best thing to do is to ban them just in case. Recently Red Deer banned e-cigarettes and in the words of Deputy Mayor Lynne Mulder a ban is reasonable “because we don't know whether it's safe or not safe, we have selected to ban it anyway."

Is it reasonable?

There is no shortage of evidence regarding the nature of e-cigarettes or of the people who are using them. Following are the five major points made by those supporting bans and then a summary of the evidence regarding those points

Just like 2nd hand smoke, 2nd hand vapour is harmful to others. We don’t know what is in that vapour and until we do we should not be exposed to it.

We do know what is in the vapour.

In the last two years both the journals Biomedcentral Public Health1 and Nicotine and Tobacco Research2 have published studies concluding that there is no harm in being exposed to second-hand vapor.

Second-hand vapor has nothing in common with second hand smoke.  It has none of the toxins that result from burning tobacco.  It is indistinguishable from what comes out of an approved and recommended pharmaceutical nicotine inhaler3. The nicotine and the trace elements found in second-hand vaper are not only a fraction of that found in cigarette smoke but fall far below Canadian federal safety guidelines. There is no danger to anyone from exposure to second-hand vapor.

It is common to state findings of various toxic elements in the liquids used in e-cigarettes but what is too often not stated is that these occur at levels far below what could harm anyone (just like arsenic levels in fruit, vegetables, game and fish4).

Claiming that we cannot know what is in 2nd hand vapor or that we cannot know if it is safe or not is clear only true if you ignore the science. There is no health evidence in support of banning vaping in public places.




The last thing we need to do from a public health perspective is have a product like e-cigarettes renormalize smoking behaviours.” - Dr. Robert Strang

Vaping does not allow people to get around smoking bans for the simple reason that it is not smoking. It is not a loophole. It is an alternative to smoking and a real threat to the tobacco industry. It is bizarre to suggest that a product that has been so successful in getting smokers to switch is undoing decades of tobacco control.  The anti-smoking movement had its origins in trying to get people to stop smoking; thanks to e-cigarettes people are quitting smoking at a greater degree than ever before.

Though some e-cigarettes may look like cigarettes, they don’t smell like them and they are about 95% less harmful.  They are such an obviously better alternative that they make cigarettes look even worse than they are. Why would anyone prefer cigarettes when they could instead use a product that doesn’t smell up their clothes and hair, tastes so much better, and is so much safer?

Regulating e-cigarettes as, or like, a tobacco product, undermines its appeal and effectiveness as an alternative to smoking.  It undermines public health to discourage smokers from trying e-cigarettes. E-cigarettes are making real inroads on replacing smoking but legislating them like tobacco products would end up supporting the tobacco industry and worse, keep curious and smokers who want to quit from trying them.

And let’s not lose sight of the big picture - if vaping can replace most smoking we would see an almost unimaginable decline in tobacco related illness.

Ultimately this is a product designed and marketed exclusively to smokers.  A recent study in the British Journal of General Practice found that just .2% of vapers (that’s 2 out of 1000) were people who had not been daily smokers5.






Gateway to tobacco use: “Many kids who might not otherwise smoke are choosing to try electronic cigarettes, and that can lead to tobacco use and addiction, which is a concern.”

First of all, legitimate studies of children experimenting with e-cigarettes such as the one from Britain’s Action on Smoking and Health6 have found that not only is it rare but that almost all children who try e-cigarettes have already tried or are smoking cigarettes.

For those kids who have never smoked, there is no evidence that using e-cigarettes (or Nicorette) leads to smoking. What we do have strong evidence for is that e-cigarettes have become the strongest gateway away from smoking - that is- the largest market for e-cigarettes are smokers who want to quit. One recently published study in Addiction Journal of 5800 smokers trying to quit found that those using e-cigarettes to quit were twice as likely to be successful at quitting as those using traditional methods like nicotine gum7. Another study from the Journal of General Internal Medicine8 found that e-cigarettes were experienced to be much more appealing and effective than nicotine inhalers and seen as a more attractive choice for smokers wanting to quit.

As far as arguing that e-cigarettes lead to smoking it would require that a person would deliberately make the choice to move to a product that also delivers nicotine but that in comparison tastes bad and is really dangerous to their health.

E-cigarettes are seriously threatening cigarette sales.  Shouldn’t we support any product that reduces the damage that smoking inflicts on public health?



The Canadian Lung Association is greatly concerned that e-cigarettes with candy-like flavours, such as chocolate and vanilla, are being marketed and sold to youth. “These products have candy-like flavours, which appeal to children and teenagers and can be bought by those under the age of 18.”

Every product that adults consume uses flavour, and adults prefer having that choice.  Flavours in e-cigarettes entice adults away from smoking.  A recent study of over 10,000 vapers found that 66% of them preferred non-tobacco flavours9. Just like the flavours added to Nicorette gum (mint, fruit, cinnamon; or Nicorette cherry lozenges or the mint inhaler)10, the flavours in e-cigarettes are not put there for kids - they are there to meet the demands of adult consumers. Adults prefer products that taste good and they like the range of flavours that make e-cigarettes so much more appealing than cigarettes.

Though people like to raise the fear of children using e-cigarettes, legitimate studies such as the one from Britain’s Action on Smoking and Health, found that not only is it rare but that almost all children who try e-cigarettes have already tried or are smoking cigarettes11.

Yes, some children will try e-cigarettes. Many more children will be trying unflavoured regular cigarettes - is it because they are attracted by the taste of tobacco? No, it’s because some children will try anything they can get their hands on. But the Canadian e-cigarette industry as a whole refuses to sell to children, and the Electronic Cigarette Trade Association of Canada supports specific federal regulations barring the selling of e-cigarettes to minors.







E-cigarettes and E-liquid have no quality control standards and are unregulated.
Even though e-cigarettes are still quite new we understand them much better than we do cigarettes. Cigarette smoke contains over 4000 chemicals but e-cigarette vapor has very few constituents which are quite easy to test for and to control. Study after study has shown that any toxins in e-cigarette vapor exist at just a fraction of what exists in cigarette smoke and even more importantly they exist at levels way below Canadian federal safety guidelines.

It is true that e-cigarettes are not regulated as health products. However, because in Canada these are sold and marketed exclusively as recreational consumer goods, they are subject to numerous and extensive federal consumer product safety guidelines.  These guidelines apply to everything from the constituents in the liquid to the child proof packaging to the labelling and even to the batteries. Everything in e-cigarettes conforms to federal standards designed specifically to safeguard the wellbeing of consumers and the public.

That being said, ECTA or the Electronic Cigarette Trade Association of Canada in cooperation with an independent accredited testing lab and scientific consultants have developed even more stringent standards than the Canadian government requires. These standards include regular third party testing.

As well, ECTA members and pretty well everyone in the domestic industry refuses to sell their products to minors. (Most of the perception of an uncontrolled industry comes from the American market which is much less safety-oriented than the Canadian market).  








In conclusion

Recently a letter from over 50 scientists from 15 different countries written to the director general of the World Health Organization warned that “excessive restrictions on lower risk products will have the unintended consequence of protecting cigarettes from competition from less hazardous alternatives. “If the WHO gets its way and extinguishes e-cigarettes, it will not only have passed up what is clearly one of the biggest public health innovations of the last three decades that could potentially save millions of lives, but it will have abrogated its own responsibility under its own charter to empower consumers to take control of their own health, something which they are already doing themselves in their millions” said Professor Gerry Stimson, Emeritus Professor at the Imperial College in London . Most of the moves to banning seem to come from confusing vaping with smoking when in fact e-cigarettes compete with and have the potential to make smoking not only seem foolish but also make it almost obsolete. Banning e-cigarettes not only supports the cigarette industry but removes the likelihood that thousands of smokers who have tried every other means might finally find the way that works for them.



By: Paul Bergen



References:

THRA.ca - Tobacco Harm Reduction Association of Canada





1 Biomedcentral Public Health: Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks.
http://www.biomedcentral.com/content/pdf/1471-2458-14-18.pdf

2 Nicotine and Tobacco Research: Secondhand Exposure to Vapors From Electronic Cigarettes
http://ntr.oxfordjournals.org/content/early/2013/12/10/ntr.ntt203.short
Using an e-cigarette in indoor environments may involuntarily expose nonusers to nicotine but not to toxic tobacco-specific combustion products.“

3 Rest of the Story: Metals in Electronic Cigarette Vapor are Below USP Standards for Metals in Inhalation Medications
http://tobaccoanalysis.blogspot.co.uk/2013/04/metals-in-electronic-cigarette-vapor.html
While the article scared many vapers by comparing the metal levels in e-cigarette vapor to that in cigarette smoke, it failed to inform readers that the levels of metals in electronic cigarettes are generally comparable to those in nicotine inhalers.”

4 http://www.foodinsight.org/Questions_and_Answers_about_Arsenic_in_Food_and_Beverages
5 British Journal of General Practice: Electronic Cigarettes: Fact and Faction. http://www.smokinginengland.info/latest-statistics/

6 Action on Smoking and Health: Use of Electronic Cigarettes in Great Britain. http://www.ash.org.uk/files/documents/ASH_891.pdf “Regular use of electronic cigarettes amongst children and young people is rare and is confined almost entirely to those who currently or have previously smoked.”
7 Addiction Journal: Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. http://onlinelibrary.wiley.com/doi/10.1111/add.12623/abstract
Among smokers who have attempted to stop without professional support, those who use e-cigarettes are more likely to report continued abstinence than those who used a licensed NRT product bought over-the-counter or no aid to cessation.  Study consisted of over 5800 adults.
8 Journal of General Internal Medicine: E-Cigarette Versus Nicotine Inhaler: Comparing the Perceptions and Experiences of Inhaled Nicotine Devices. http://link.springer.com/article/10.1007/s11606-014-2889-7

10 Nicorette Gum. http://www.nicorette.ca/products/gum

11 Action on Smoking and Health: Use of Electronic Cigarettes in Great Britain. http://www.ash.org.uk/files/documents/ASH_891.pdf

10 comments:

  1. This is a clear explanation of the whole picture about the use of personal vaporizers. I do not understand why something that is so clearly a wonderful innovation that will save millions of lives is so vilified. As a 44 year smoker who expected to die because of a smoking addiction I could not escape, I consider personal vaporizers a miracle for me and it breaks my heart that it is not being recognized as such as a gift for all smoking humanity and those that love us.

    ReplyDelete
    Replies
    1. I feel the same way Chris, I hear ya! 16 year smoker, quit after 7 days. 3 years tobacco free :-)

      Delete
  2. i aswell smoked for 12+ years just had a baby daughter and trying my hardest to quit tried everything under the sun with no real success until i bought a nice ecig and some juice....promote this dont ban it plz its a miracle!

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  3. It is time. It is time we all openly become critical of those seeking to silence us. It is time to raise the gateway to deception and state our case along with these experts who are aware and caring enough to fully practice their ethical commitment in aiding anyone and everyone needing aid for a healthier life. It is time to support one another. Please let your voice be heard. Vape Safe!

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