ECigs: ETech Meets Public Health Again (Part One)


One of my Twitter healthcare friends tweeted this morning, with some evident concern, about the issue of 3D printed guns.

Regular readers of this blog have already heard about this, and the counter argument that it isn’t the 3D printed guns that are the problem, but the ammo, and OOPS, we already have 3D printed ammunition, also.

So, yes, this is an issue with an emerging technology, and it is a public health issue. When I blogged about it before, I didn’t make that overt and explicit. I assumed people would figure that out on their own. But now I am thinking perhaps I should make more overt some of the issues I’m tracking which have potential health impacts.

This brings me to the topic of electronic cigarettes, a relatively recent technological approach to changing how people smoke for recreational purposes. This weekend I collected over 40 (FORTY!!) hashtags from the conversation space around electronic cigarettes. That should be another post, later. For those new to the idea, eCigs have become a big deal awfully quickly. And it is extremely complicated. I’m just going to pull out a very few tweets illustrating some of the potential health issues in the conversation.

The thought here is that electronic cigarettes can be and ARE BEING used as smoking cessation devices, kind of like the nicotine patch, but more like actually smoking.

In fact, the “healthiness” of electronic cigarettes is one of the leading marketing justifications.

But there are some who question the safety and “healthiness” of the electronic cigarettes. Like, um, the American Cancer Society? And the American Lung Association. And the FDA.

American Cancer Society: Electronic Cigarettes – Boon, Bane, Blessing, or Boondoggle? (2011) http://www.cancer.org/cancer/news/expertvoices/post/2011/05/03/electronic-cigarettes-e28093-boon-bane-blessing-or-boondoggle.aspx

American Cancer Society: Restrict the Sale of Electronic Cigarettes: http://www.cancer.org/myacs/eastern/areahighlights/cancernynj-news-ny-ecig-health-vote

American Cancer Society: What about electronic cigarettes? Aren’t they safe? (2013) http://www.cancer.org/cancer/cancercauses/tobaccocancer/questionsaboutsmokingtobaccoandhealth/questions-about-smoking-tobacco-and-health-e-cigarettes

Reactions against official organizations with concerns about e-cigs are vigorous. These are a couple of the lighter and tamer responses.

American Lung Association: E-cigarettes: Another Option to Help You Quit Smoking? http://www.lung.org/associations/states/florida/educational-programs/e-cigarettes.html

American Lung Association: Some say vaping e-cigarettes is worse than smoking the real thing: http://www.lung.org/associations/states/florida/news/top-story-in-the-news/some-say-vaping-e-cigarettes.html

FDA: Electronic Cigarettes (e-Cigarettes) http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm

FDA: E-Cigarettes: Questions and Answers: http://www.fda.gov/forconsumers/consumerupdates/ucm225210.htm

FDA: For Consumers: Health Fraud: Electronic Cigarettes: http://www.fda.gov/ForConsumers/ProtectYourself/HealthFraud/ucm267560.htm

Whoa. Despite the FDA information above, and despite demands that the FDA involve itself in the topic (and demands for the reverse), there is no move at this time to manage the claims and safety of e-cigarettes at the federal level. The FDA is, however, collecting information and opinions on whether or not they should be involved.

While the FDA considers, states are actively involved.

The link in the tweet leads to information asking the broader e-cig community to sign a petition to block the North Carolina House Bill 864 / Senate Bill 530, Prohibit E-Cigarette Sales to Minors.

e-Cigarette Forum

Why is the legislature so concerned about sales to minors? I’m not sure, but it might have something to do with the eCig liquids being flavored, many of them tasting like candy.

If you look at the petition page, you immediately notice alerts highlighting other states and local legislatures with similar initiatives regarding e-cigs.

CASAA Calls to Action (e-Cigs)

CASAA is a lobbying and advocacy organization for the e-cig community, and they collect the wide array of state and local initiatives to regulate e-cigarettes in the United States. Just in the past month, CASAA alerts mentioned Oklahoma, Rhode Island, Louisiana, New York City, Maine, California, North Carolina, South Carolina, and Washington.

“Perhaps most surprising is that when the topic of electronic cigarettes was finally pushed enough that the panel had to respond more adequately, it seemed clear they had no idea what electronic cigarettes were. When presenters offered to let the panel hold, pass around, and inspect their e-cigs, it was clear they had either never seen one or had only seen the ones that very closely resemble conventional cigarettes. And yet, the board was ready to discuss and vote on bills that would affect their control within the city.”
Creating Unintended Consequences: http://www.ecigadvanced.com/blog/creating-unintended-consequences/

Not just the USA, either. Other countries are even more aggressively opposed to e-cigarettes, and the e-cig community is equally passionate in their stance that the research evidence does not support the negative claims.

Up in a puff of smoke? EU plan threatens e-cigarettes: Anti-smoking groups angry at new directive which could price devices out of market
http://www.independent.co.uk/news/world/europe/up-in-a-puff-of-smoke-eu-plan-threatens-ecigarettes-8554820.html

Safer Alternative to Cigarettes to Be Banned by EU: http://www.huffingtonpost.co.uk/janice-atkinson/safer-alternative-to-cigarettes-banned-by-eu_b_2827043.html

“I used to smoke cigarettes, until I switched to E cigs. For me they are a healthier way to deliver nicotine They come in all sorts of shape and sizes and do not necessarily look like a real cigarette. E Cigs can prevent 750,000 premature death per year. Now the EU want to regulate them out of existence This will force me and others back to conventional cigarettes The EU’s policy is to “quit or die”. I do not not want to do either.”

Smoke without fire: The Story of the electronic cigarette: https://www.thunderclap.it/projects/1931-smoke-without-fire

There are concerns about the safety, as well as oversight of the ingredients and consistent production criteria and quality control (as mentioned earlier in the FDA links).

Maryland Injury Lawyers: Are Electronic Cigarettes Dangerous Products? http://www.maryland-injury-lawyer.com/2012/02/are-electronic-cigarettes-dang.html

But, like I said before, it’s complicated. Last month an article was published in JMIR about health effects reported in those online forums for “vaping”.

“A total of 405 different symptoms due to e-cigarette use were reported from three forums. Of these, 78 were positive, 326 were negative, and one was neutral.”
Hua My, Alfi M, Talbot P. Health-Related Effects Reported by Electronic Cigarette Users in Online Forums. J Med Internet Res 2013;15(4):e59 http://www.jmir.org/2013/4/e59/ PMID: 23567935

Check out the research yourself. What do you think?

Pubmed: “electronic cigarettes” OR “electronic cigarette” OR “e-cigarette” OR “e-cigarettes” OR “ecig” OR “e-cig” OR “e-cigs” OR “e-cigs”

End of Part One. Part Two digs deeper into some of the social and cultural aspects of vaping, which also have potential health impacts.

4 responses to “ECigs: ETech Meets Public Health Again (Part One)

  1. You wrote:

    “But, like I said before, it’s complicated. Last month an article was published in JMIR about health effects reported in those online forums for “vaping”. ”

    From that study ;

    Methods:
    “A Google Internet search was performed using the words “electronic cigarette forum” to identify online e-cigarette forums with “health and safety sections” that allowed posts on the health effects experienced when using e-cigarettes. The three websites with the highest number of posts in health and safety sections were selected for study (Electronic Cigarette Forum posts = 543, Vapers Forum posts = 34, and Vapor Talk posts = 55). Data were collected from posts on these websites through July 15, 2011, and the Electronic Cigarette Forum, which had the most entries, was analyzed in detail. Only data reported directly by an e-cigarette user were included.”

    The forum subsections that this study collected its data from often only have users submit negative experiences when something goes wrong. People dont post in those forum subsections when they, for example, have no symptoms, and have been off tobacco smoke for months. If data is only collected from these forum subsections, the results will always slant towards negative experiences. No one knows if their symptoms are related to e-cigarette use or not. It’s only because it’s often the only obvious recent change in their life at the time, that they point to it and ask questions.

    Case in Point : Myself. 3 months into using an electronic cigarette, I was getting very strong chest pains. I put the e-cigarette away for a week, but the pain continued. Turned out to be nothing related to e-cigarette use. Fixed my Diet up, continued to use my electronic cigarette, and haven’t had any symptoms since. But I did ask about it on the Vape forums at the time. And it probably made it’s way into this statistic that is being used to over regulate e-cigarettes.

    The study you mentioned is a clear example of cherry picking of data. It is ludicrous that it has been brought up in EU discussions about ecig regulation.

    • I agree that the data source is questionable, as self-report often is, as well as n=1 examples, and there are no controls. Absolutely more research needed, with better data sources. Very early days for this.

  2. Personally, I support e-cigarettes. At least with this product, smokers can control their unhealthy habits and stop forcing people around them to be passive smokers. Being passive smokers suck and it’s very unhealthy. You don’t smoke but you have the same chance of being ill from inhaling tobacco smoke. Due to these reasons, I believe European Union’s attempt to ban the use and sale of e-cigarettes is ridiculous. It’s also ironic that in New York City Health Council hearings, panel members who oppose e-cigarette usage actually had very little idea about pros and cons of e-cigarettes. Are these people simply afraid of something they have no idea about?

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