Electronic Cigarettes – Health Risks of the Electric Vapor Cigarette

IMPORTANT point to understand

The question is NOT whether electric cigarettes are 100% SAFE or not, the question is if vapor cigarettes are less harmful than tobacco cigarettes or not!

There are two sides to the story!

According to many doctors, professors and associations such as the American Association of Public Health Physicians (AAPHP; read their statements below), the electronic cigarette is much less harmful than conventional tobacco cigarettes. This is because properly manufactured and regulated electronic cigarettes do not contain tobacco and therefore do not produce 4000+ chemicals and 40+ carcinogens that cause lung cancer and heart disease.

Then what’s the problem?

There are basically TWO problems.

1. Electric cigarettes are still relatively new and have not been tested enough. Nicotine delivery through the skin (nicotine patches) or orally (chewing gum, lozenges) has been approved by the FDA (NRTs: Nicotine Replacement Therapies). They have been shown to be harmless. However, effects of inhaling pure nicotine are NOT known and sufficient studies have not been carried out yet, especially by the FDA.
2. Because they are available for purchase online and in regular shops etc., they can be bought with relative ease by underage smokers, that is obviously not good!

July 2009 FDA statement

It is mainly because of these two reasons that electronic cigarettes are still not approved in the USA (even though they are approved in many European countries). In July 2009, the FDA made a statement through a press release saying that laboratory tests conducted by them showed that some of the samples they tested had toxic chemicals such as diethylene glycol. This infuriated a lot of people because the FDA didn’t mention that this chemical is only toxic at high levels and that it is found in approved NRTs, asthma inhalers and air fresheners.

Responses to the FDA statement

We have listed below responses from doctors, professors and well respected associations to this press release from the FDA and we invite you to read them as that will help you understand the big picture about electronic cigarettes.

“AAPHP favors a permissive approach to E-cigarettes because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years.”

“Conventional cigarettes account for about 80% of nicotine consumption in the United States, but more than 98% of the illness and death. This harm is not caused by the nicotine, but by toxic products of combustion. A cigarette smoker can reduce his or her risk of future tobacco-related death by 98% or better by switching to a low risk smokeless tobacco product. He or she could cut that risk by 99.9% or better by switching to a nicotine-only delivery product like one of the pharmaceutical products or E-cigarettes”

Reference: AAPHP Statement re State Regulation of E-cigarettes

“For the first time we report the effect on the rat of long-term (two years) inhalation of nicotine. The rats breathed in a chamber with nicotine at a concentration giving twice the plasma concentration found in heavy smokers. Nicotine was given for 20 h a day, five days a week during a two-year period. We could not find any increase in mortality, in atherosclerosis or frequency of tumors in these rats compared with controls. Particularly, there was no microscopic or macroscopic lung tumors nor any increase in pulmonary neuroendocrine cells. Throughout the study, however, the body weight of the nicotine exposed rats was reduced as compared with controls. In conclusion, our study does not indicate any harmful effect of nicotine when given in its pure form by inhalation.”

Reference: Long-term effects of inhaled nicotine

“This is the first time that objective measures of smoking cessation are reported for smokers who quit successfully after using an E-cigarette. This was accomplished in smokers who repeatedly failed in previous attempts with professional smoking cessation assistance using the usual nicotine dependence treatments and smoking cessation counselling.”

Reference: Successful smoking cessation with electronic cigarettes in smokers with a documented history of recurring relapses: a case series

“CONCLUSION: The use of e-Cigarette substantially decreased cigarette consumption without causing significant side effects in smokers not intending to quit (http://ClinicalTrials.gov number NCT01195597).”

Reference: Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study

“Introduction Recent genetic evidence has implicated nicotine as a possible cause of cancer, suggesting the need to examine the potential contributions of nicotine itself to cancer versus the confounding effects of addiction and thus exposures to known carcinogens. The objective of this study was to examine the relationship between nicotine replacement therapy, smoking, and cancer outcomes.”

“Discussion Although the surveillance time was short, smoking predicted cancer in this analysis and nicotine replacement therapy did not.”

Reference: Does nicotine replacement therapy cause cancer? Evidence from the Lung Health Study

“The U.S. Food and Drug Administration today announced that a laboratory analysis of electronic cigarette samples has found that they contain carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze.”

“These products are marketed and sold to young people and are readily available online and in shopping malls. In addition, these products do not contain any health warnings comparable to FDA-approved nicotine replacement products or conventional cigarettes. They are also available in different flavors, such as chocolate and mint, which may appeal to young people.”

Reference: FDA and Public Health Experts Warn About Electronic Cigarettes

“E-cigarettes deliver the same nicotine found in the pharmaceutical products, with no more contamination by toxic substances than the pharmaceutical products already approved by FDA. Propylene glycol and glycerin are used as carriers of the nicotine. These cause the visible vapor. These substances are generally recognized as safe. They are commonly used in theatrical fog machines, asthma inhalers and air fresheners. There is no smoke, and no products of combustion. All this creates a situation in which we can confidently state that the risk to others sharing an indoor environment with one or more vapers (E-cigarette users actively using this product) is almost sure to be much less than 1% the risk posed by environmental tobacco smoke. Pharmaceutical nicotine vaporizers have been in use for years, with no visible vapor, and no apparent concern about use in non-smoking areas.”

Reference: AAPHP Statement re State Regulation of E-cigarettes

“The limited studies done to date by FDA on E-cigarette liquid, and publicly announced July 22, 2009 (Attachments B5a-c) prove that the products tested have levels of carcinogenic contaminants similar to the concentrations of these same contaminants in nicotine replacement products already approved by FDA (AttachmentsB5d-i). These levels are several orders of magnitude less than conventional cigarette smoke.”

Reference: Citizen Petition to Follow-up July 22, 2009 Press Conference on E-cigarettes

“E-cigarettes use the same nicotine, with about the same level of trace contaminants as FDA approved NRT products. There are a large number of studies and reviews that demonstrate the safety of E-cigarettes in comparison with pharmaceutical NRT products and conventional cigarettes (Attachments B6a-j). Propylene glycol and the other major ingredients in E-cigarettes are generally recognized as safe (Attachment B6i).”

Reference: Citizen Petition to Follow-up July 22, 2009 Press Conference on E-cigarettes

“A U.S. judge on Thursday granted a preliminary injunction barring the Obama administration from trying to regulate electronic cigarettes (as drug-device combinations) and prevent them from being imported into the United States. In a sharply worded decision, U.S. District Judge Richard Leon scolded the Food and Drug Administration for trying to assert jurisdiction over the cigarettes, which are battery-powered or rechargeable devices that vaporize a liquid nicotine solution. “This case appears to be yet another example of FDA’s aggressive efforts to regulate recreational tobacco products as drugs or devices,” he said in granting an injunction barring the FDA from regulating the cigarettes as a drug-device combination.”

“Judge Leon, in his January 14, 2010 opinion, stated the following: “Together, both Smoking Everywhere and NJOY have already sold hundreds of thousands of electronic cigarettes, yet FDA cites no evidence that those electronic cigarettes are any more an immediate threat to public health and safety than traditional cigarettes, which are readily available to the public” (Attachment B3).”

Reference: Citizen Petition to Follow-up July 22, 2009 Press Conference on E-cigarettes

“A group of prominent doctors and tobacco researchers, including Dr. Michael Siegel at the Boston University School of Public Health, Dr. Joel Nitzkin of the AAPHP Tobacco Control Task Force, and Dr. Brad Rodu, Endowed Chair, Tobacco Harm Reduction Research University of Louisville, challenge the FDA to provide the full quantitative data of the study upon which the FDA has based its warning against electronic cigarettes. They are concerned that the FDA’s disingenuous targeting of electronic cigarettes through a biased presentation of the scientific data has had significant negative impact upon the public perception of electronic cigarettes, when the best available evidence suggests that these have shown that the devices offer great potential to reduce serious health issues among traditional tobacco smokers.”

“In a July 22 news release, the FDA cited the detectable presence of carcinogens and “toxic chemicals” in a “small sample” of electronic cigarette cartridges as reason for alarm, singling out nitrosamines as particularly toxic. What the FDA fails to inform the public is that detectable amounts of carcinogens are also present in nicotine replacement products such as NicoDerm CQ and Nicorette gum, both approved by the FDA, and nitrosamines that can be also found in food items such bacon and beer. This double standard and alarmist attitude has had the significant and unfortunate effect of inducing hysteria among the public, discouraging tobacco smokers from using a product which is thought to be a significantly safer alternative to traditional tobacco.”

“The FDA’s laboratory findings actually indicate that electronic cigarettes are much, much safer than conventional cigarettes,” says Dr. Michael Siegel. ”The traces of carcinogens present are also present in nicotine replacement products. The FDA and the anti-smoking groups have fallen into a huge analytical trap as they have failed to ask the appropriate question. The question they are asking is: ‘Are electronic cigarettes safe?’ That is not the right question. The right question is: ‘Are electronic cigarettes much safer than traditional ones?’”

Reference: Prominent Public Health Physicians and Tobacco Researchers Expose Double Standard in the FDA’s Recent Study of Electronic Cigarettes and Challenge the FDA’s Alarmist Attitude Toward the Devices

 ”In contrast, the level of tobacco-specific nitrosamines present in tobacco products are 300 to 1400 times higher. On a weight-for-weight basis, Marlboro has 1400 times higher the level of tobacco-specific nitrosamines than an electronic cigarette cartridge.”

“Moreover, there are approximately 56 other carcinogens that have been identified to be present at high levels in tobacco smoke, while there are no other carcinogens that have been identified to be present in electronic cigarettes.”

“Based on these data, and upon knowledge that the conventional cigarette contains at least 10,000 other chemicals, including known toxins and carcinogens, while the electronic cigarette does not, there is exceedingly strong evidence that electronic cigarettes are much, much safer than conventional ones.”

Reference: Comparison of Carcinogen Levels Shows that Electronic Cigarettes are Much Safer Than Conventional Ones