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. 

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