Electronic Cigarette – A Safe Way To Quit Smoking?
Electronic cigarette is a hot topic right now. As New York considers becoming the first state to ban electronic cigarettes, debate surrounds these devices and their safety.
A Discovery News article (http://news.discovery.com/human/e-cigarettes-health-nicotine-tobacco-110127.html) discusses whether electronic cigarettes should be considered safe or not; but even more important is a recent scientific research published by the community health sciences professor, Michael Siegel, at Boston University School of Public Health.
Jenny Jenkins, the owner of an online e-cigarette and quit smoking news blog at http://www.ecigjenny.com quotes: “I found a very interesting scientific study today about electronic cigarettes, their safety and effect on reducing the damage that smoking regular tobacco cigarettes causes.”
What are Electronic Cigarettes and Why are They Novel?
Electronic cigarettes are hand-held devices that deliver nicotine to the user through the battery-powered vaporization of a nicotine/propylene-glycol solution. The act of ‘smoking’ an electronic cigarette is called ‘vaping’ and it mimics smoking; but, there is no combustion and the user inhales vapor, not smoke.
Although the nicotine is derived from tobacco, electronic cigarettes contain no tobacco. Theoretically, we would expect vaping to be less harmful than smoking as it delivers nicotine without the thousands of known and unknown toxicants in tobacco smoke.
Moreover, a product that mimics the act of smoking, in addition to delivering nicotine, can address both pharmacological and behavioral components of cigarette addiction.
Electronic cigarettes are not manufactured or distributed by the tobacco industry or by the pharmaceutical industry. Hundreds of small distributors market them over the internet and in shopping mall kiosks. They have been on the market in the United States for more than 3 years and have become increasingly popular.
Review of Evidence Regarding the Safety of Electronic Cigarettes
As only 5300 of the estimated 10,000 – 100,000 chemicals in cigarette smoke have ever been identified, we already have more comprehensive knowledge of the chemical constituents of electronic cigarettes than tobacco ones.
We were able to identify 16 studies that have characterized, quite extensively, the components contained in electronic cigarette liquid and vapor using gas chromatography mass spectrometry (GC-MS). These studies demonstrate that the primary components of electronic cigarette cartridges are propylene glycol (PG), glycerin, and nicotine.
Of the other chemicals identified, the FDA has focused on potential health hazards associated with two: tobacco-specific nitrosamines (TSNAs) and diethylene glycol (DEG).
TSNAs have been detected in two studies at trace levels. The maximum level of total TSNAs reported was 8.2 ng/g. This compares with a similar level of 8.0 ng in a nicotine patch, and it is orders of magnitude lower than TSNA levels in regular cigarettes.
Electronic cigarettes contain only 0.07–0.2 per cent of the TSNAs present in cigarettes, a 500-fold to 1400-fold reduction in concentration.
Although the existing research does not warrant a conclusion that electronic cigarettes are safe in absolute terms and further clinical studies are needed to comprehensively assess the safety of electronic cigarettes, a preponderance of the available evidence shows them to be much safer than tobacco cigarettes and comparable in toxicity to conventional nicotine replacement products.
Review of Evidence about the Effectiveness of Electronic Cigarettes in Smoking Cessation
Evidence suggests that electronic cigarettes are capable of reducing cigarette craving, but that the effect is not due exclusively to nicotine.
Bullen et al observe that: ”the reduction in desire to smoke in the first 10 min[utes] of [electronic cigarette] use appears to be independent of nicotine absorption.”
The sizable craving reduction achieved by the ‘placebo’ – a nicotine-free electronic cigarette – demonstrates the ability of physical stimuli to suppress cravings independently. Many studies have established the ability of denicotinized cigarettes to provide craving relief.
Analysis of Arguments in Light of the Emergence of Electronic Cigarettes:
Argument #1: Skepticism about the role of combusted products in harm reduction
Electronic cigarettes, such as NRT, are not tobacco products and no combustion takes place.
Argument #2: Alternatives promoted as safer may actually be equally or more dangerous
Thus far, none of the more than 10,000 chemicals present in tobacco smoke, including over 40 known carcinogens, has been shown to be present in the cartridges or vapor of electronic cigarettes in anything greater than trace quantities.
No one has reported adverse effects, although this product has been on the market for more than 3 years. Still, the FDA struck a more ominous tone in its July 2009 press release, warning of the presence of carcinogens at ‘detectable’ levels.
Yet it failed to mention that the levels of these carcinogens was similar to that in NRT (Nicotine Replacement Therapy) products. Whereas electronic cigarettes cannot be considered absolutely safe, as there is no threshold for carcinogenesis, they are undoubtedly safer than tobacco cigarettes.
Argument #3: Big Tobacco cannot be trusted
Electronic cigarettes are not tobacco products and not produced by tobacco companies. They were invented in Beijing by a Chinese pharmacist Hon Lik, whose employer, Golden Dragon Holdings, ‘was so inspired that it changed its name to Ruyan (meaning “like smoke”) and started selling abroad’.
Rather than being helpful to cigarette makers, electronic cigarettes compete directly against them. 32 Thus David Sweanor, adjunct law professor specializing in tobacco control issues at the University of Ottawa, says they are ‘exactly what the tobacco companies have been afraid of all these years’.
Tobacco cigarettes are the leading cause of disease in the United States, which is why the ‘primary goal of tobacco control is to reduce mortality and morbidity associated with tobacco use.’
Electronic cigarettes are designed to mitigate tobacco-related disease by reducing cigarette consumption and smoking rates. The evidence reviewed in this article suggests that electronic cigarettes are a much safer alternative to tobacco cigarettes. They are likely to improve upon the efficacy of traditional pharmacotherapy for smoking cessation.
The essential rationale for the FDA’s pre-market approval process – to keep dangerous products out of the marketplace – may not easily extend to new nicotine products because a range of extraordinarily deadly nicotine products is already grandfathered into the market.
This has led to an awkward nicotine regulatory structure where dirty tobacco products face few barriers to market entry whereas cleaner products are subject to oft onerous hurdles.
To read the full article, visit: http://www.hsph.harvard.edu/centers-institutes/population-development/files/article.jphp.pdf
Jenny Jenkins states: ”Awesome research if you ask me. Busts several myths and makes very logical conclusions. It’s great to see that government sites like PubMed (U.S. National Library of MedicineNational Institutes of Health) host and distribute this material - http://www.ncbi.nlm.nih.gov/pubmed/21150942 .”
She concludes: ”I hope more people will give finally electronic cigarettes a try and stop ruining their health and the health of their loved ones.”
Those interested in helping her spread the word, may share her article on FaceBook at http://www.facebook.com/pages/Quit-Smoking-With-An-Electronic-Cigarette/194514870560773
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