Electronic cigarettes: Help or hazard?

Blogs are tough to write and even harder not to write.  But then came news that Harvard, which is a University occasionally referenced somewhere between Yonkers, N.Y. and Portland, Maine. I believe at one time it was considered a prestigious and unbiased think tank of research and provocative experimental query. In a brief break from the St. Francis series this interesting piece came  into the written world of scientific commentary-


Electronic Cigarettes: Health or Hazard? by Harvey B. Simon, M.D. an Associate Professor described in bio as; "The author of many consumer health publications, Dr. Simon is dedicated to informing people about health and medicine."

The first line that struck me after reading this dribble is from a Dickens novel (A Christmas Carol):

"If they would die they had better do it and decrease the surplus population."


To paraphrase the simple tenant that is expressed is that traditional NRT therapy is FDA approved and is therefore safe.  This would imply that traditional NRT therapies work and have not been attempted by any individual who uses an e-cigarette.  It also implies that the e-cigarette is being used for cessation and not for its actual role as a replacement for the combustion based tobacco products. The average e-cigarette user, given the removal of e-cigarette availability, would resume smoking cigarettes.  As a result they would become exposed to the carcinogenic materials related to cigarette use.  If Boston University's stance cited below is cited, they are 98-99% safer using e-cigarettes.  Thus it is a directive of this article to go NRT, which most e-cigarette users have tried multiple times with no success or resume combustable tobacco.


Next remember the success rates of NRT's is miserable, albeit better than placebo.  The relative exposure to TSNA's with NRT therapy is similar to e-cigarettes, thus there is no benefit there. Let us also not forget that one of the approved methods for cessation, Chantix, carries a  black box warning.


Primum non nocere- at first do no harm.  To attempt to remove a working solution for a serious medical problem is calling the smoker a pariah of society, a weak individual with no willpower and therefore if they cannot find a solution to their nicotine dependence- the Dicken's line becomes a valid inference of this articles conclusions.

In this report' in his unreviewed  Harvard Health Blog, the good Dr. points out to us four strong reasons that e-cigarettes are as yet not to be deemed ready to be given the green light.

1.       First, the dose of nicotine delivered with each puff may vary substantially. An FDA analysis recorded nicotine doses between 26.8 and 43.2 micrograms per puff. It also detected nicotine in products labeled as nicotine free.

2.      Second, electronic cigarettes deliver an array of other chemicals, including diethylene glycol (a highly toxic substance), various nitrosamines (powerful carcinogens found in tobacco), and at least four other chemicals suspected of being harmful to humans. To be sure, the dose of these compounds is generally smaller than found in “real” cigarette smoke. But it isn’t zero. (Italics added by this author).

3.     Third, by simulating the cigarette experience, electronic cigarettes might reactivate the habit in ex-smokers. They could also be a gateway into tobacco abuse for young people who are not yet hooked.  (bolding and underlining added by blogger).

4.     Earlier in the article he noted, "A study published this spring in the American Journal of Preventive Medicine concluded that electronic cigarettes may help smokers quit. Whether they are a safe way to quit is another question—preliminary studies from the FDA, New Zealand, and Greece raise some concerns. (Italics added by article's author). 

He did neglect to mention several key pieces of research that were available at the time of the article. More about that later.


What is reality:

1.     Nicotine levels in vapor from e-cigarette variation seems quite irrelevant as we know from animal and human studies that the smoker self regulates nicotine levels during the day.  The average amount of nicotine from a cigarette is 1 mg.  Taking the highest concentration "per puff" that he reports, the vaper would need 23 inhalations to get the same nicotine dosage as one cigarette.  Thus the question raised is-"What possible issue is raised here if indeed the nicotine amount a vaper obtains is lower than that of a smoker?"

2.     The second point is quite literally a rant that continues to be played over and over again and comes from a series of 18 samples of e-liquid.  A trace in one vial was found of the chemical diethylene glycol.  Elaine Keller best summed this in a comment to the posted article,"The FDA press release about their study raised concerns by employing two propaganda techniques: Lying by Omission and Stereotyping. The FDA failed to provide the quantitative analysis, showing that the amount of TSNAs they found is no larger than the amount in an FDA-approved nicotine patch, and failed to mention that the amount of Diethylene Glycol found in 1 of 18 cartridges tested (0.01 ml) is too minuscule to present any danger whatsoever of poisoning the user. They compounded this by failing to mention that they found nothing at all harmful in the vapor."  Yet they used powerful words like diethylene glycol, found in anti-freeze.  As for TSNAs in e-cigarettes vs. tobacco smoke the this was noted to be present albeit generally smaller than cigarettes. In fact one 16 mg bottle of e-liquid had 1200 times less TSNAs than 20 cigarettes.  How about just saying it is extremely less or dramatically less than tobacco. Generally less is actually a falsehood and suggests they could be higher than some cigarettes.

3.    Please tell me what the words might and may have anything to do with fact.  These are words of pseudo factual nature.  I could easily say the Empire State Building might walk across to a new setting or cosmic rays may lead youths to have schizophrenic breaks.  These are fear-mongering tactics based on no data I have seen.

4.    And of course the referenced article's word "may" is italicized, another not so subliminal way of emphasis that he did not use in is could and might statements.

And then there is the omission of published reports that show very positive evidence for safety and future in e-cigarette harm reduction.

Contrary to FDA recommendations that electronic cigarette users should switch to FDA approved smoking cessation products, new research in the International Journal of Clinical Practice, conducted by J. Fouls, a professor at Penn State University, College of Medicine, Cancer Institute, confirms that the change could reverse the health gain achieved. Health risks associated with the use of e-cigs are likely much smaller (if any) than smoking traditional cigarettes and can potentially yield a large health benefit. Yet, the FDA and other anti-smoking organizations continue to adamantly claim electronic cigarettes are dangerous for your health.  In his study, Penn State Professor J. Foulds, states that: "for those who have successfully switched to e-cigs, the priority should be staying off cigarettes" proving that recommending that ex-smokers who use electronic cigarettes switch back to FDA approved NRT's could have devastating health consequences."

As explained by Michael B. Siegel who is a professor of community health sciences at the Boston University School of Public Health "the distinct and unique advantage of e-cigarettes is that they allow individuals to utilize one device that can simultaneously address nicotine withdrawal, psychological factors, and behavioral cues that serve as barriers to smoking abstinence. The finding that most individuals who used e-cigarettes at least reduced the number of tobacco cigarettes they smoked suggests that if proven safe, e-cigarettes may be a potentially important tool for harm reduction, especially among smokers who have found currently available pharmaceutical smoking-cessation options to be ineffective."

The Electronic Cigarette

http://www.healthnz.co.nz/ElectronicCigsDarwinOct09.pdf ,

Electronic cigarettes as a harm reduction
strategy for tobacco control: A step forward
or a repeat of past mistakes?
http://www.hsph.harvard.edu/centers-institutes/population-development/files/article.jphp.pdf,

Consumer Reports Health:

http://news.consumerreports.org/health/2011/09/popularity-of-e-cigarettes-grows-but-little-still-known-about-them.html

Overall to paraphrase another commentator- This is unethical reporting.  Partial truths and omission of information to provide choice for any consumer is yellow journalism.  In this case using credentials, a University's name too give oneself prestige and making recommendations on the health behaviors of others without equal representation of data is proof enough.

The above is evidence enough that my esteemed colleague (bless his heart) is a dangerous and unethical human being.  Harvard needs to pull this article or at least have a person of substance review these posts.


I want to thank Elaine Keller, Kristinnm, Thad Marney and all the others who commented on the URL http://www.health.harvard.edu/blog/electronic-cigarettes-help-or-hazard-201109223395#comment-6367. Their insights (or in one case lack of insight,none of the above referenced)  made this a learning and fascinating adventure.  Forgive my plagiarism.


Thank-you for reading, comment please freely and honestly. 

Please visit this site, explore it and if you find yourself of like thought and mind, join and feel free to contribute to a cause run by some of the most caring advocates of Tobacco Harm Reduction.  Volunteers who give time, effort, support and direction toward a healthier World from a realistic standpoint.

Lord, make me an instrument of your peace.

First of all, this Blog is most certainly not meant to be a teaching of any religion or ideology.  It is a mere reflection of a writing I first entered into in a Philosophy of Religion class many years ago when I was at the SUNY at Buffalo.  At the time my religion was science and my creator evolution.  My how life events change one's outlook.

Lord may be substituted with whatever word is reflective of your spiritual guide, be that as it may I have no problem with at this moment taking it from St. Francis and his experience.

To hate is a horrible thing, hate has no empathy and evokes unthinkable acts of violence, segregation and revenge.  Hate is an emotional nightmare that spurns resolution.  I was recently robbed and my identity compromised.  I have anger toward the perpetrators, but I do not hate them. I have hated- the War in Vietnam, people who have raped, people who have tortured and killed.  A very wise man extolled upon me the understanding of hate, that it was anger with no outlet and no healing.

I strive now to understand the human psyche from an empathic view and not a view that brings about my own schema (frame of reference).

Of course we hate the Cowboys or the Packers- that is not hate, it is dislike.

Conflicts are inevitable and must not be repressed or ignored but worked through painfully and carefully. We must develop the skills of being sensitive to oppression and grievances, sharing power in decision making, creating consensus, and making reparation....Let us reject the clamour of fear and listen to the whisperings of hope. Quaker Yearly Meeting, 1987 New Zealand.

My Uncle Dugald, died for peace in the great War to end Wars.  He was 21 and believed he would make a difference.  If you ever get the chance to listen to, "The Green Fields of France":

                      http://www.YouTube.com/watch?v=6UvQ52A7ksM&feature=related 

There is a line:

The sun's shining down on these green fields of France;
The warm wind blows gently, and the red poppies dance.
The trenches have vanished long under the plow;
No gas and no barbed wire, no guns firing now.
But here in this graveyard that's still No Man's Land
The countless white crosses in mute witness stand
To man's blind indifference to his fellow man.
And a whole generation who were butchered and damned.

And the holocaust, the lynchings of black men, 9/11, WWII, Hiroshima, and again and again and again and again.

We confuse peace with maintaining peace.  We confuse love for one another with feuds, blame, and methodologies of noble causes that seem right and profound and lose ourselves in the outcome of our actions, thinking that somehow peace is to be won if the battle is won.

But then we must have the message of St. Francis- let me be the instrument of your peace.  Let me be a manifestation of the Quaker statement that war, schisms of thoughts, defeating an enemy that may have the same goals is far from being and instrument of peace. Sensitivity to the real problem- death and dying,  As was pointed out recently money doesn't decrease smoking or harm reduction- smoking has been the behavior that has always been the one addiction that some people cannot end.

It is the current equivalent of No Man's Land. The unfathomable ANTZ idea that if you just stop and don't start up again, we have no argument- is filled with the fallacy that smokers are somehow weak.

It is time to take our swords and hammer them into tools for mutual combat.  Prevention is our instrument of peace, harm reduction, an entry point, and research the eventual goal.

We must all take today as the first day of a crusade of compromise and understanding. What truly will decrease the lives lost and the families shattered.

Lord, make me an instrument of your peace.  Let me not have to win the battle of how, let me be a part of the solution, let me understand what I can take from my opponent and let me help my opponent understand what they can take from me. 

And I mean all of the above, the problem is that there are profits and motives and self proclaimed demigods who can see nothing but their own self interests and their own agendas.  These are the dangerous factions who use fear as their weapon.  They have to be right, they see themselves as the grand knights in glistening armor pouring their energies into a cause, a crusade that can tolerate nothing but abstinence and servitude.  They speak like Moses and act like Stalin.  Their armor is that of deception and supposition.  The cause is mighty, their cause is just, their tactics selective and their words made to seem powerful through repetition of partial truths and neglect of evidence contrary to their ultimate solution. 

It is an Orwellian stance, thoughtspeak with the Syme's of the world decimated by entering logic and intellectual process into a battle that has no place for any dissent.  Black and white, any gray is apportioned to the cause to obliterate the good.

There will be no curiosity, no enjoyment of the process of life. All competing pleasures will be destroyed. But always—do not forget this, Winston—always there will be the intoxication of power, constantly increasing and constantly growing subtler. Always, at every moment, there will be the thrill of victory, the sensation of trampling on an enemy who is helpless. If you want a picture of the future, imagine a boot stamping on a human face—forever.                    - George Orwell, 1984

There is no conversation in this observation.  There is no understanding, there is no place for personal victory defined as an increase in the feeling of wellness of an individual. There is only truth as defined by indisputable science, which in itself would be the first to admit that contradictions and differential interpretations make science fluid and ever altering in its conclusions.  Facts can be rendered from data; there is no doubt that smoking tobacco has negative consequences.  There is no doubt that complete abstinence would be physically beneficial.  There is also no doubt that there is a population of individuals that are dependent on tobacco and that there are less harmful means of addressing this issue.  These are realities.  Zero tolerance evokes the Prohibition Era and the madness that came forth from essentially medicinalizing alcohol.

As in the Orwellian principal of life, intellectual enthusiasm is dangerous to societal stability.  The loyal who question, even enthusiastically for the cause, are a danger to the outcome and as happened to poor Syme in 1984, even those with similar agendas must be vaporized.

Is this overly dramatic?  Unfortunately no, for the availability of a means of reducing death, pain, suffering and external exposure is at risk of being removed from access.  There is hope in recent studies that point to benefits of alternative nicotine sources that appear much less harmful.  The problem of problems is that Harm Reduction is being introduced by people who have tried to stop smoking but have not succeeded.  The technology may be external, but the movement to expand non-pharmaceutical nicotine replacements with alternative nicotine access modes- vaping specifically- was a grassroots method.  It has been a method to remove the primary carcinogens from tobacco and the dangers of smoke and particulate carried toxins which are the result of pyrolysis- burning.  Vaping is a vaporization of a solution of nicotine, FDA approved PG and VG, water and flavorings.

Vaping is a remedy of the desperate that have failed traditional tobacco cessation treatments and have conquered the behavioral and the nicotine pharmacological activity need with this method. 

But it was not intended to be a means to quit nicotine, it was intended to replace cigarettes.  Many people vape solutions without nicotine as the behavioral habit is soothing.  And nicotine is in itself being looked at for the management of Alzheimer's disease, help with concentration and performance.  (It is now being looked at by several sports organizations as a performance enhancing drug.

Is it carcinogenic, not in itself.  Is it a tumor promoter, in some cases it may be.  Is it a tumor initiator, very little evidence.

Intolerance and a mindset engulfed with anger cannot see reality, it constructs its own reality. 

The same materials that I discussed above are blasted by the demigods as major reasons for bans,  They call vapor smoke, a revelation of their lack of the knowledge of physics.  Is there freedom for an individual to use an alternative tobacco form by choice, no say the demigods. 

Why?  Because it will be transformed into a Pharma product and become prescription and strength regulated.  Because it can  be taxed heavily, the most irrational idea is to tax an agent less harmful at the rate of a more harmful agent.

And much worse is science in itself, seeing grants and careers built around proof of tolerability.

Banning e-cigarettes destines 500 people die each day unnecessarily.

Big Brother would be pleased.  I recall a response to a blog pro-choice regarding e-cigarette use:

"I say give the bloody bastards all the tobacco they need, let them develop their cancers and let them suffer- one less smoker is one step to obliteration of this foul and perverted population".

Lord, make me the instrument of your Peace-

1. make me a vessel of love that moves the minds of the ANTZ and allows for tolerance.
2. help me be a tool for the compassion man can have to his fellow man
3. make my enemy understand truth, that he would join to reduce the death
4. we right- are they right. If right is to be loyal to a cause, we must just stay loyal.

Note I didn't say who was right. 

We are the Symes of the world. We do not sit idly and be trampled, that is to admit we are not trying to prove a point. We are not perfect, we know the alternatives, medications and patches didn't help. 

We are the pioneers, and plead our case and move to find fact. We are grateful to have a means to avoid tobacco smoke.

Being right will take care of itself.

And if there had been more talk back in 1916, then I might have known my Great-Uncle Dugald as a man and not a story and a cross in the green fields of France.  and make no man feel forced to return to the world of burned tobacco

Why do the Heathens Rage

There is a certain sadness when a common goal is destroyed by intolerance and hard lined viewpoints that do not allow for alternative solutions to a mutual issue. This has been a theme that has been a part of the history of mankind.  We look deftly into the face of a problem and naturally have an opinion. 


Of course this blog is about nicotine, tobacco and the consequences of use of various forms.  It is formost about intolerance and the lack of the need for this approach.  Passionate and well meaning human beings are often thrust into opposition by black and white thinking, by misrepresentation of truths and by a reality they see as choice.

Take the story of King Solomon, better known as the Judgement of King Solomon. Two women claim to be the mother of a child and come before Solomon for a solution,  Solomon orders the child to be cleaved in half so each mother will have their fair share.  As the story is told the wise judge sees the real mother willing to allow the false one to have the child rather than allow for its slaughter.  Solomon is seen as wise and predictive of such a response and awards her the child.  In one view this is a brilliant and insightful action.  Another view is this is  demonstrative of black and white thinking.  There is cohersion and if the sword is too quick the infant is killed.  It is a Sunday school story every child is exposed to in the course of their education,  And that is more the reason for bringing this up in this article.  Somehow this is viewed as a positive lesson for the child, that of the empathic mother willing to lose the child to the imposter rather than see it  killed. The other message to the child is that force and threats of death lead to justice. 

Tobacco smoke is a carcinogen. It is a weight on the health care system, a source of great income to those that provide cigarettes to the public and a killer of 400,000 people yearly in the US alone.  It is seen as a choice undertaken by the smoker that demands punishment and restriction. To all non-smokers out there, especially those who passionately fight to ban, restrict and punitively tax the consumers of tobacco, you have my blessing.  If indeed it is the desire that you want a smoke free and healthier world then we are on the same page.

The means to that end is where we differ. 

Envision yourself in my shoes, in my life and experience.  Both my parents smoked for at least 10 years before I was conceived.  The germ cells that eventually met to produce the embryonic me were bathed in nicotine for those years.  I grew up in a haze of smoke, given the ANTZ opinion, nicotine and toxins surrounded me throughout my childhood.  I was smoking regularly by 14, but had never been free of tobacco exposure.  I have never been nicotine free.  I have used patches, gum, Chantix (almost killed me due to depression- from which I have never recovered completely) and various other treatments.  Now comes a method of nicotine availability that is seemingly safer for me and you and the black and white thinking of the all or nothing approach looks to decimate that option.  I have never been cigarette free for this long since 14. 

If my hypothetical gesture that I have been nicotine exposed for 10 years longer than I have been alive is valid, and the method I obtain that is through vaping- why are you not supporting this as a positive change.  I feel healthier, I don't cough, wheeze, get short of breath.  If I were diabetic and needed insulin to stay healthy, would you deprive me of that resource.  Insulin can kill a child if it ingests it.  Diabetes treatment is expensive and drains the health care system, causes severe morbidity even with treatment and disables millions. 

Well diabetes is a disease. 

True, and juvenile diabetics, Type I certainly didn't bring that on themselves.  But Type II diabetes- the adult onset type is related to diet, obesity and alcoholism.  Where is the rage and black and white thinking with this group. 

Solomon would do what in this dilemna.  Would he take away the less toxic (that's what the literature points to) vaping and say go back to tobacco cigarettes and die earlier.

I don't think so, Solomon would not cut my e-cig in half.

We as sentient beings need to look at the real culprits- the tobacco lobby, the pharmaceutical companies and government.  All three lose income and lose power to the vaping community.  They are a mutual enemy that we should be seeing as a mutual foe.  They will all profit less from sales and taxation. 

Don't let me leave you believing that nicotine is a completely risk free entity for the user.  It is not, but it is a great deal less toxic than tobacco smoke.  It is a tumor promotor in some cancers. 

There are numerous health compromising agents out there that deserve attention.  Fast food, smog, global warming, drugs like Chantix, sloth and obesity.  We all make choices.

Compromise starts with understanding and compassion.  This is not a problem that will go away.  If you think it is something Federal and local policies will address- think again,  The FDA is allowing nicotine free cigarettes to be sanctioned for Phase IIb trials.  How backwards is that in its logic.  All the toxins without the nicotine, 

Conflict is a part of life and a free society.  Conflict resolution demands understanding the fears and concerns of the other party.  There are many people who share the same nicotine exposure patterns that mirror my own.  Sit down with your child and parent them.  Put SNUS and lozenges behind counters.  Proactively make nicotine access an adult choice.  There is much more for us to agree with than to disagree with.

Vaping isn't a means to lure children into tobacco use. 

Oklahoma has a wonderful song about the farmers and the ranchers should be friends.  It fits here.

The Berlin wall came down, the nuclear arms race seems to have melted into the backround, Boston won a World Series- if those things can occur so can the diagreements in our camps.

Let he or she without sin cast the first stone.  Won't be me.

  

Prayer of Saint Francis of Assisi

Lord, make me an instrument of your peace.
Where there is hatred, let me sow love;
where there is injury,pardon;
where there is doubt, faith;
where there is despair, hope;
where there is darkness, light;
and where there is sadness, joy.


O Divine Master, grant that I may not so much seek
to be consoled as to console;
to be understood as to understand;
to be loved as to love.
For it is in giving that we receive;
it is in pardoning that we are pardoned;
and it is in dying that we are born to eternal life. Amen

This is a site for the accumulation of the knowledge of how to deal with
the ANTZ-  and to accurately deal with certain traits that are associated
with this species of collective thought collections.   ANTZ is the perfect
term (first used by Kristin at CASAA), and the ant the perfect societal
model for the behavior of this class of (well intentioned) one focused
no tobacco, save the world, Zealots.   Hence the anti nicotine tobacco
zealot movement.  The ANTZ.  In most of the major controversies in
this world, there is an acknowledgement that there is a middle ground
around which a battle is fought.  Global warming is one scenario where
there is some understanding that cycles of varying earth temperature
is inevitable, the battle is over how much man can add to the changes
in temperature.

This blog will speak to issues through the eyes of all and attempt to produce
a somewhat more realistic counter to ANTZ LOGIC.

Once to twice a week a line from St. Francis will be looked at in the face of
this controversy.

Today a simple intro.

.