So, Electronic Cigarettes - do they deliver?

What's in a real cigarette?
A cigarette may look harmless enough - tobacco leaves covered in classic white paper. But when it burns, it releases a dangerous cocktail of about 4,000 chemicals including:

  • more than 70 cancer-causing chemicals (including tar, arsenic, benzene, cadmium, polonium-210, and more)
  • hundreds of other poisons (including hydrogen cyonide, amonia, carbon monoxide...)
  • nicotine, a highly addictive drug, and many additives designed to make cigarettes taste nicer and keep smokers hooked.

You can learn more about these chemicals, by visiting the Cancer Research UK website.

What is an electronic cigarette?
Well, although it may sometimes look like one, it is not really a cigarette at all. The electronic cigarette is also known as an “e-cig”, “an e-cigarette”, “a personal vaporizer”, a “PV”, a “nicotine vaporizer” and many other things. They are battery-powered devices filled with liquid nicotine (a highly addictive chemical) that is dissolved in a solution of water and propylene glycol.

Although the nicotine is derived from tobacco, electronic cigarettes contain no tobacco.

How Do They Work?
Often termed "vaping," when you take a puff on the end of the e-cigarette tube, a battery heats up the nicotine, which creates a vapor that is then inhaled into the lungs. The end result is a sensation of smoke in the mouth and lungs without really smoking.

Research into e-cigarettes?
There is a lot of scare mongering, sensationalist, unverified presentations of alleged research but little proper, peer reviewed research into electronic cigarettes.

There is some however.

Cahn and Siegel Study
Professors Cahn and Siegel worked at the Department of Political Sciences at the University of California at Berkeley at the time of the study (they may still do). Their study has been published in the Journal of Public Health Policy.

Some useful parts of their paper are highlighted below:

We were able to identify 16 studies that have characterized the components contained in electronic cigarette liquid and vapor using gas chromatography mass spectrometry. 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.6 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. The presence of DEG in one of the 18 cartridges studied by the US Food and Drug Administration (FDA) is worrisome, yet none of the other 15 studies found any DEG. The use of a non-pharmaceutical grade of PG may explain this contamination.

Other than TSNAs and DEG, few, if any, chemicals at levels detected in electronic cigarettes raise serious health concerns. 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.

Two published studies have examined the effectiveness of the product by measuring their effect on cravings and other short-term indicators. Bullen et al demonstrated that electronic cigarettes deliver nicotine effectively, more rapidly than a nicotine inhaler. In this study, electronic cigarette use significantly reduced craving, a similar effect to what was observed with a nicotine inhaler. Nicotine delivery and reduction in cigarette craving was much less than with a regular cigarette. Eissenberg found that 10 puffs on one brand of electronic cigarettes delivered a small amount of nicotine, again far less than a tobacco cigarette, whereas another brand delivered little to none. The first brand was able to significantly reduce cigarette craving.

Taken together, this 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.

Barrett found that denicotinized cigarettes reduce cravings more than a nicotinized inhaler, supporting Buchhalter et al's conclusion that although some withdrawal symptoms can be treated effectively with NRT, others, such as intense cravings, respond better to smoking-related stimuli.

Cahn and Siegel go on to review the most common arguments against harm reduction. You can read these by buying a copy of their paper.

So to summarise the above:
- electronic cigarettes are far far less harmful than real cigarettes
- the level of TSNAs found in electronic cigarettes is similar to nicotine patches
- DEG was only found in 1 out of 16 studies suggesting that the problem was with the particular e-liquid used
- they address both the pharmacologic and behavioral components of cigarette addiction
- electronic cigarettes deliver nicotine effectively, more rapidly than a nicotine inhaler
- a nicotine-free electronic cigarette is capable of suppressing the cravings independently.

Poolsa Study
Polosa and colleagues found a potential link between use of electronic cigarettes and reduction in number of cigarettes used per day. This 6-month pilot study evaluated 40 regular smokers not intending to quit who were given the opportunity to use e-cigarettes. A sustained 50% reduction in the number of cigarettes smoked was noted in about one third of patients at week 24. Over 22% of patients discontinued using cigarettes at week 24; however, most of them were still using e-cigarettes.
This study would suggest that electronic cigarettes are a viable and effective replacement for real cigarettes.

Unpublished Research
Dr. Konstantinos Farsalinos of the Onassis Cardiac Surgery Center in Athens told the annual meeting of the European Society of Cardiology that "Electronic cigarettes are not a healthy habit but they are a safer alternative to tobacco cigarettes. ... Considering the extreme hazards associated with cigarette smoking, currently available data suggest that electronic cigarettes are far less harmful and substituting tobacco with electronic cigarettes may be beneficial to health." Farsalinos and his team examined the heart function of 20 young smokers before and after smoking one tobacco cigarette against that of 22 e-cigarette users before and after using the device for seven minutes. While the tobacco smokers suffered significant heart dysfunction, including raised blood pressure and heart rate, those using e-cigarettes had only a slight elevation in blood pressure. The Greek clinical study was the first in the world to look at the cardiac effects of e-cigarettes. Another small study, also in Greece, reported earlier in 2012 the devices had little impact on lung function.

Research carried out at the University of East London on the effects of using an electronic cigarette to reduce cravings in regular tobacco smokers showed that there was no significant reported difference between smokers who inhaled vapour containing nicotine and those who inhaled a placebo vapour containing no nicotine. The report concluded that although electronic cigarettes can be effective in reducing nicotine-related withdrawal symptoms, the nicotine content does not appear to be of central importance, and other smoking related cues (such as taste or vapour resembling smoke) may account for the reduction in discomfort associated with tobacco abstinence in the short term.

A study presented at the European Respiratory Society’s annual meeting in Vienna in February, 2012 demonstrated an abrupt increase in airway resistance leading to a lower level of oxygen in the bloodstream in electronic cigarette users. In their small study, the Athens researchers studied the effects of the electronic cigarettes on 8 people who never smoked, along with 24 smokers-11 with normal lung function and 13 participants with asthma or chronic obstructive pulmonary disease (COPD). The study participants all used an electronic cigarette for 10 minutes. The researchers stated that it was unclear whether this increase in resistance had any potential long term effects.

Additional Support for e cigarettes
As of April 2010, The American Association of Public Health Physicians (AAPHP) supports electronic cigarettes sales to adults "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." However, the AAPHP is against sales to minors. You can view a copy of their statement here.

Convinced now that electronic cigarettes are much safer than real cigarettes?


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