Tag Archives: chemicals

Kelvin Choi is a liar

by Carl V Phillips

A new ANTZ on the scene seems to be aspiring to be the new Ellen Hahn.  I supposed it is possible, given that he is at University of Minnesota that he aspires to the be the new Stephen Hecht, but that might be a stretch since Hecht seems to do somewhat useful bench science, and then just lies about the health and political implications.  Choi, by contrast, seems to be fully ensconced in the “public health” junk science paradigm.  Consider this recent abstract:

Objectives. We assessed the characteristics associated with the awareness, perceptions, and use of electronic nicotine delivery systems (e-cigarettes) among young adults. Methods. We collected data in 2010-2011 from a cohort of 2624 US Midwestern adults aged 20 to 28 years. We assessed awareness and use of e-cigarettes, perceptions of them as a smoking cessation aid, and beliefs about their harmfulness and addictiveness relative to cigarettes and estimated their associations with demographic characteristics, smoking status, and peer smoking. Results. Overall, 69.9% of respondents were aware of e-cigarettes, 7.0% had ever used e-cigarettes, and 1.2% had used e-cigarettes in the past 30 days. Men, current and former smokers, and participants who had at least 1 close friend who smoked were more likely to be aware of and to have used e-cigarettes. Among those who were aware of e-cigarettes, 44.5% agreed e-cigarettes can help people quit smoking, 52.8% agreed e-cigarettes are less harmful than cigarettes, and 26.3% agreed e-cigarettes are less addictive than cigarettes. Conclusions. Health communication interventions to provide correct information about e-cigarettes and regulation of e-cigarette marketing may be effective in reducing young adults’ experimentation with e-cigarettes. (Am J Public Health. Published online ahead of print January 17, 2013: e1-e6. doi:10.2105/AJPH.2012.300947).

Let’s set aside obvious problems, like the limited value for anything other than historical tracking of an awareness survey about e-cigarettes from 2010, or describing 20-something-year-olds as “experimenting”, as if they are children.  (Many of those crazy kids are also experimenting with buying houses, military service, and parenthood.)  Consider the core conclusion.  How can a simple cross-sectional survey of awareness and belief tell us anything about the effects of communication and regulatory interventions?  If you said, “I have no idea”, you nailed it.  It is a complete lie that the conclusion follows from the research.

And, of course, there is the little matter of which bits of information he wants to correct.  Does he want to help the 55.5% who do not realize that e-cigarettes help smokers quit?  Or is it the 47.2% who do not realize they are lower risk than smoking?  As you might guess, it is the ones who actually know the truth that he wants to “correct”.

(Note:  I trust my regular readers will recognize as subtle ridicule my use of three significant figures in reporting those numbers.  As anyone who understands sampling — and anyone familiar with my writing — knows that reporting that level of unwarranted precision is a bit of junk science in itself.)

There is some potential usefulness in the actual survey in terms of helping us learn about the rate of at which accurate knowledge of e-cigarettes and THR has spread.  However, what has no apparent usefulness are Choi’s thoughts and opinions, as evidenced by this interview.

I will skip past his first answer, a remarkably amateurish description of what e-cigarettes are, something that could be corrected by basically anyone who is familiar with the topic.  (But go ahead and read the whole interview if you are inclined to find unintentional comedy in ANTZ rantings — it is a good one for that.)  I skip that because it gets far worse:

There are a variety of reasons why e-cigarettes are unhealthy. First, they contain nicotine, which is a known addictive chemical. A recent study conducted by Vansickel and Eissenberg found that experienced e-cigarette users can obtain a significant amount of nicotine through e-cigarettes, which may be comparable to smoking cigarettes.

E-cigarettes deliver nicotine?  Who knew?  Glad we had that study (by the guy who originally claimed just the opposite and never admitted his error — but that is another story).  And the reason that they are unhealthy is that this chemical is addictive (whatever the heck that means), not because it is harmful.  Choi might want to ask for a tuition refund from whoever claims to have taught him about health.

Second, previous chemical analyses of the e-cigarette nicotine liquid found that some samples contain tobacco-specific cancer-causing agents and anti-freeze.

Yawn.  Yes, this PhD “researcher” cannot do any better than some random county public health nurse, citing the propaganda (rather than the actual scientific results) from the FDA.  Another tuition refund, please.  Oh, but wait.  Maybe that nurse could do better.  She probably would not claim that e-cigarettes actually “contain…anti-freeze” [sic], but merely “an ingredient found in antifreeze”.  The latter form of this is an example of lying with literal truths, of course, as previously discussed in this blog (did you know that breast milk contains an ingredient found in antifreeze?!! we should stop nursing babies immediately!).  Apparently Hahn Junior does not even realize that he is reciting propaganda meant to confuse people — he is among the genuinely confused.

Third, with the product being promoted as a cigarette alternative at places where smoking is not allowed, smokers may use these products to sustain their nicotine addiction, and may therefore be less likely to quit smoking

And another “problem” that is not an actual health risk from e-cigarettes.  That “where smoking is not allowed” pseudo-argument deserves a post or two of its own, which I will do that soon.  So today I will politely refrain from pointing out how utterly moronic it is.

And that is all he offers.  Not even a single claim of health risk.  Apparently he wants to keep people from “experimenting” with e-cigarettes because they… …um… cause no health risk at all.

Oh, but it gets dumber.  So much dumber.

I think the perception of e-cigarettes as cessation aids is of the greatest concern. First, this perception may drive young adults to use e-cigarettes when trying to quit smoking instead of proven-effective cessation treatments. To date, no studies have shown that e-cigarettes are more effective than proven-effective cessation treatments such as nicotine replacement therapy and counseling. Therefore, e-cigarettes may hinder young adult smokers from quitting smoking.

E-cigarettes are (correctly) perceived as being useful for quitting smoking?  Well, that is a dire concern indeed.  As for the claim they are not shown to be more effective than other methods that are “proven” to help a mid-single-digit percentage of smokers quit (to charitably take a best-case figure from the biased research on the topic), so what?  Even setting aside the fact that he is baldly lying about that — the evidence strongly supports the claim that e-cigarettes are more effective — how exactly do they prevent someone who wants to quit smoking from trying those other methods if the e-cigarettes do not work?

Anyone with a basic understanding about smokers and quitting — even at the casual layperson level of knowing actual humans who smoke or smoked — understands that most people who are interested in quitting try multiple methods.  How exactly can one method, even if he genuinely believes it is of no value at all, interfere with the others?  Does he really think that smokers are so dumb as to say “well, I wanted to quit and tried an e-cigarette, but it did not work for me, so I will just keep smoking because I have never heard of any other method I might try.”  Gee, if only there were some way to inform smokers that the powers-that-be think they should try NRT and counseling.  Someone should really get on that.

And if Choi really believes that introducing a new method of quitting will actually prevent the use of other options, does he rail against the introduction of new NRT products or counseling methods because they will keep people from trying the existing methods he thinks are actually “proven”?  I didn’t think so.

In short, either he has not even given enough thought to this topic to be considered even a generally aware layperson, and so is grossly lying about his expertise, or he is just making up lies because he wants a ride on the ANTZ gravy train.

Is there more?  Oh, yes, there is more.  It will have to wait until the next post.

An agenda for (useful) e-cigarette chemistry research

posted by Carl V Phillips

This is a bit off topic, but it follows from recent posts and this blog is where I have the most readership that will be interested.  Following up in particular on this post and the extensive comments therein (especially those from Mike Siegel, Konstantinos Farsalinos, and Spike Babaian) and in consultation with my colleague Igor Burstyn, the following is my assessment of what would be most useful for further research on the chemistry of e-cigarettes.

Right now, the research agenda seems to be driven by attempts by anti-harm-reduction activists to show that e-cigarette vapor contains measurable level of “toxins”, along with responses by others that in all the samples that have been studied, the levels of these toxins are below anything that we should worry about.  These have been done.  They are both established.  It is time to move on and do something that is useful for making sure that e-cigarettes are consistently as low-risk as is practical.

Researchers who have been studying cigarettes for decades have fallen into a laziness trap of believing they are in a static world where all exposures are exactly the same.  This is not true even in that world.  (Despite a favorite lie of the researchers in this area, it is obviously inevitable that some cigarettes pose less risk than others.  Indeed, the difference in risk among cigarettes probably dwarfs any differences among all the smoke-free alternatives, but that is a topic for later.)  The homogeneity assumption is even less true (when thinking in relative terms) in the world of e-cigarettes; variations from product-to-product and year-to-year are huge compared to the results of interest.

So the urge to do the simplest possible research, to just study a few e-cigarettes under one particular circumstance and imply that the results represent e-cigarettes in general, is misguided.  A study of a few particular products can only produce lasting knowledge by assuming all products are and will continue to be similar, which is not useful in general and is particularly not useful for understanding what might lead to a substantial increase in risk for a particular product.  At the low levels of contamination of interest, there will be too much variation for that extrapolation.

That said, there is no use in throwing out the data we already have, though to a remarkable extent that is what has been done because it is almost impossible to make sense of the existing studies.  With that in mind, the first item in the agenda for useful research would be to consolidate existing information from the several vapor studies that have already been done, from the original Ruyan study up to the present.  The results of these studies have been reported in such incommensurate ways, and so incompletely (with the exception of that first one, which provided the detailed reporting that is a defining characteristic for anything to deserve to be called “published”), that there may be a lot to learn from them by simply consolidating the information — particularly where the analyses discussed below are actually possible but simply were not reported.

This should include an effort to collect unreported information from the original researchers, which they should be willing to provide so long as they are interested in legitimate science and not cheap propaganda.  (Subtext:  It will be interesting to see if the US FDA provides their information, or if they are just going to admit that they fall into the latter category.)  It would be relatively inexpensive, and I am confident I could find someone who has not been involved in any of the studies or the debates to do it if the community and the industry could come up with funding — a small fraction of the funding that went into the recently published vapor study.

The main need for the research agenda, though, is creating results that offer generalizable information.  Future studies should focus on the mapping from e-cigarette liquid to the vapor, as a function of the technical specifics of the atomizer and e-cigarette hardware.  That is, instead of just learning what a few sample liquids and devices happen to create, in terms of vapor chemistry, what we really want to know is how to measure the liquid, consider the device, and then predict the vapor chemistry.

It will always be the case that measuring the liquid chemistry is relatively cheap and easy, while measuring the vapor is expensive and finicky.  Analyzing the liquid’s chemistry is cheap enough that it could become a standard part of the manufacturing process, or at least a frequently-used form of quality control.  But, of course, what we would really like to know is what is in the vapor that is produced from the liquid and inhaled, and so the mapping is far more useful than knowledge about one particular vapor sample.

Along the same lines, would be the mapping from vapor chemistry to the chemistry of what is exhaled by the vaper into the environment.  This is of rather less real practical interest, given how very little is actually exhaled and how minimal the apparent risk from vapor is even before this reduction.  But so long as there is political warring over “second hand vapor” there will be a demand for this also.  To the extent that anyone wants to study exhaled vapor, they should do it in ways that produce the most useful information, particularly comparing the vapor chemistry (sans human), but also looking at effects of behavior and comparisons to exhaled pure air (is that formaldehyde coming from the people or the vapor?)  Indeed, human subjects ethics demands that we get as much useful information as possible when we are using people in experiments.

Focusing future studies on the mapping will merely require doing the easier measurements alongside the difficult ones, and doing a decent job of reporting the full methodology and results (i.e., adhering to the standards of science, not of public health journals).  If someone is setting out to measure vapor chemistry, they just need to do the comparatively cheap and easy measurement of the same liquid’s chemistry at the same time, and also report exactly what was used to create the vapor.  Ideally this should include some useful technical measurements of the vaporization process, like what temperature was attained, but at least a report of the e-cigarette’s technical specifications would be of some use.

One of the biggest open questions about e-cigarette chemistry is whether some particular contaminants found in vapor are in the liquid already or are caused by the vaporization process, and if the latter, is this is an inevitable result of the entire technology or are there ways to reduce it (should there be any health concern at all).  It is really quite amazing that in 2012 we still only have what might be called “decent guesses” about this.  This relates to the more general question of whether it is enough to know the liquid chemistry to be confident that the unintended unhealthful exposures are trivial, or do we need to know something else.

There is no excuse for wasting resources doing e-cigarette chemistry studies that do not seek to determine the mapping.  There is almost no downside, other than a modest increase in the cost of the study.  The effect on information produced will be entirely positive; the usual throw-away result — what happened to be in this particular sample from this particular product, on particular day — will still be there if someone really thinks there is value in it.  Indeed, that will be doubled because there will be information about the chemistry at two stages.  But the real value will be the relationship between them.

[UPDATE: This conversation continues here.]

Another study confirms lack of concern about vapor toxicity – too bad about that press release and some of the details

posted by Carl V Phillips

I have to leave my series on what constitutes useful evidence as a cliffhanger for another day or two, because people are clamoring for my comments on the latest in the series of studies about e-cigarette vapor chemistry that was recently published.  (Article summary here; full version is paywalled.)  The study tends to confirm what we already knew about vapor, and the fact that it does not contain important quantities of unexpected toxins.  This is certainly good news for e-cigarette users (vapers) and THR advocates.

Before continuing with the study, though, it is worth tying this in to the current series I interrupted and asking, “How did we know that?”  The bulk of the evidence comes not from the half-dozen or so lab studies that have been done, but from the basic chemistry and physics of the situation.

That is, how do we know that e-cigarette vapor is not similar to cigarette smoke?  The same way that we know that it is not similar to monkey urine — with our scientific reasoning process that says, “Why would we ever even expect it to be similar?”  Cigarette smoke is produced by burning complex plant matter which produces a lot of the many known products of combustion and a little bit of more chemicals than we could ever count.  E-cigarette vapor is produced by heating a liquid of (mostly) known chemistry, very much not like plant matter, into a vapor phase with little change in the chemistry other than its physical state.  The best evidence that we have that they are different is right there in that reasoning.

One of the biggest mistakes that THR advocates can make is to implicitly endorse the anti-scientific tactics of anti-THR activists, who would pretend that most of the evidence does not exist.  In other words, it is a potentially fatal error to send the message, “Because of this study and the handful that came before, we know…” rather than the more accurate and useful observation, “Before the first study was ever done, we were 99% sure that…, and these studies show that, indeed, we did not overlook anything in our previous reasoning.”

If you live by the one-off little study, you will die by the one-off little study.  There is an obvious response, by those who seek to prevent harm reduction, to all of the chemistry studies that have been done (including those spun by the anti-THR liars, which have actually shown the same good news as the others).  They can say, “these only looked at a few samples of the product, and we do not know what might be in other or current products.”  This is a reasonable response, though ultimately not true.

It would be completely true if I had phrased it differently, substituting “they do not provide observations about what might be in…” rather than “we do not know what might be in…”.  “We do not know” is a lie is because of all the rest of our knowledge, apart from the handful of studies.  But if we seem to be claiming the handful of studies are what really matters, we are arguing the liars’ case — after all, eventually one of these little studies will get a bad result due to lab error or real contamination.

Circling back, what is contained in the “…” a few paragraphs back?  The main observation there is that e-cigarette vapor contains the same stuff as e-cigarette liquid (disbursed into air), in obvious contrast to cigarette smoke, which is obviously not just the contents of an unlit cigarette plus air.

Should we be worried about unwanted chemicals in e-cigarette vapor, then?  Well, basically: garbage in, garbage out.  That is, whatever is in the liquid will end up in the vapor.  If the liquid is contaminated with something that should not be there, it will also be the vapor (though this creates approximately a zillion times as much concern for the vaper herself as for any bystanders for reasons elaborated upon below).

Is there some chemical activity that might depart from this observation?  Not much, but perhaps some.  And therein lies the very unfortunate limitation of the new study.  Its value would have been dramatically increased had they analyzed the chemistry of the same liquid that was used to produce the vapor, a step that would have been quite easy and inexpensive.  Any important differences would give us new (because it would be unexpected) information that might help in creating better products.  If there result were the expected correspondence, however, it would help reassure us that studying only the liquid chemistry (much easier and quite practical to do for samples from every large-scale production run, and for some portion of small batches) would be roughly as useful as more complicated aerosol studies.

Of course, that tells us what the vaper is exposed to, rather than those sharing space with the vaper (who we expect will breathe some of whatever was exhaled by the vaper, just as we always breathe whatever people around us are exhaling).  This is important because much of the rhetoric coming from the anti-THR liars claims that the exposure of bystanders justifies enacting bans on the use of e-cigarettes in public, and even private, places.  But the exposures of bystanders are going to be attenuated compared to vapers by both dilution (a little bit of vapor in a lot of air) and absorption (most of the content stays in the user unless he is intentionally quick-puffing in order to make a cloud rather than to more effectively deliver nicotine by holding the vapor longer).

The recent German study — which was spun by the authors’  and others’ anti-THR lies (links above) as showing a serious risk to bystanders when it actually showed quite the opposite — looked at exhaled vapor, providing a better measure of the actual environmental exposure.  The new study, unfortunately, just diluted the vapor that the vaper would inhale, a rather odd arbitrary methodology.  This was apparently supposed to offer some measure of what a bystander would be exposed to, but it fails to do that.  Mostly what it does is make all of the quantitative results meaningless, except in relation to each other.  The arbitrariness is clearly illustrated by considering what would happen if, instead of diluting the vapor into roughly half a cubic meter of air [the rest of the paragraph is UPDATED based on first comment] and then apparently multiplying the concentrations as if this were diluted to a 40 m^3 room, they had diluted it into a different volume.  In an alternative scenario, the concentrations would have all been changed by some multiplicative factor, assuming we ignore any actual effects of the room (gravity, adherence to solid surfaces).  Moreover, even if they chose the “right” dilution factor (whatever that might be), this would still not mimic the exposure of a bystander (read on).

This means that only the relative results matter.  The relative comparison is made is to cigarettes smoke, but we already knew that there was a big difference.  The comparison does not answer the question about whether the real-world concentration of chemicals from e-cigarettes is “too much” (whatever that might be judged to be by a hypothetical rational and honest policy process).  A similar observation about the sensitivity to the dilution mattering is true for any study of vapor (or smoke) also, but in this case the dilution factor was utterly arbitrary.  It was far smaller than a room['s dilution given that that large number of puffs represents a lot of vaping time], but far larger than someone’s lungs.

I bring up lungs again because, despite how this study was spun, this was a study of “first hand vapor” not “second hand vapor”.  The methodology description is a bit incomplete, but it is pretty clear that there was no attempt to simulate the process of the vaper absorbing most of the content of the vapor or a smoker absorbing the smoke to which it was being compared.  Yet the press release had the very unfortunate headline, “New e-cigarette study show no risk from environmental vapor exposure”.  The second-biggest flaw in this headline is the reference to environmental exposure, which was not studied.  Unfortunately, two of the people quoted in the press release make the same mistake as the headline, with one of them even making the error of referring to “second hand vapor”.

Of course, if what the user is exposed to does not contain anything we should be worried about, then the much lower exposure of the bystander is even less worrisome.  But, again, we know that because it is obvious for numerous reasons, not because of this study.

Finally, there is that “no risk” claim.  This is another example of the overblown claims that — as I argued previously — will ultimately harm the cause, not help it.  First, a chemistry study is not a health study, and does not include any measures of health outcomes.  This study looked at more results than the example of overblown claims I cited in the previous post, but that other study had the advantage of measuring health outcomes.  A claim like “found levels of environmental exposure that are not considered worrisome for health” would be fine, but no actual health claim can be made based on chemistry results like these.

Second, the claim “no” (as in “no effect”) is never a legitimate scientific claim.  “Too small to measure” — great.  “Showed no evidence of an effect” — fine.  But we can never be sure there is no effect.  It is generally suspected that nicotine is a little bit harmful, though the effects are too small to measure.  Some people are definitely sensitive to polypropylene glycol exposure.  Further similar observations can be made about the contaminants.  So if someone breathes enough of the vapor (and, again, the absolute concentrations that were measured were totally arbitrary), there could well be some harm.  Nothing is gained by pretending otherwise.

Finally, as a policy analyst, I have to strongly object to treating natural science results as if they provide policy analysis as was done in the press release (though not in the actual article).  Do these results show that we should not ban vaping in any indoor spaces?  Definitely not.  Nor would have less-reassuring results shown that we should ban indoor vaping in some indoor spaces.  Such claims require both a statement of the ethical basis for imposing restrictions on people’s choices and the accompanying economics (assessment of costs and benefits) which would be informed by the natural science results.  That requires several more steps than are ever included in a research report.

Americans for Nonsmokers’ Rights makes false claims about hazards of electronic cigarettes

posted by Elaine Keller

AUTHORS NOTE: This is Part 2 of 2 addressing the press release issued on September 26 by the anti-smoker group, Americans for Nonsmokers’ Rights (ANR). Yesterday’s post addressed the smoking cessation issue. Today’s post addresses the ANR’s misleading statements about the safety of vapor.

SPRINGFIELD, VA October 2, 2012

E-cigarette users who have achieved smoking abstinence report improvements in their health ranging from a reduction in COPD and asthma symptoms to better markers of cardiovascular health such as blood pressure and lipid measures. Researchers have found no increase in blood pressure or heart rate among subjects trying e-cigarettes for the first time.

“What I find most egregious about the ANR’s recent press release,” stated Elaine Keller, President of The Consumer Advocates for Smoke-free Alternatives Association, “is their statement that e-cigarettes pollute indoor air with ‘detectable levels of carcinogens and other toxic chemicals.’ ANR is trying to manipulate non-smokers into wrongly believing that e-cigarettes threaten the health of bystanders. The truth is that there is absolutely no indication that electronic cigarettes pose any appreciable risk to bystanders. Tragically, these kinds of devious tactics may actually prevent smokers from saving their health and their lives by switching to this low-risk alternative.”

The Indoor Air study cited in the ANR’s press release did report finding six chemicals in the air after a subject used an e-cigarette in a sealed 10 cubic meter stainless steel chamber. The Air was sampled for 15 minutes. However, the highest concentration of any of these chemicals was formaldehyde, measured at 16 micrograms per cubic meter, which equates to 12.86 parts per BILLION (ppb.) The OSHA Short Term Exposure Limit (15 minutes) for workers exposed to formaldehyde in the workplace is 15.5 times higher, at 2 parts per million (ppm), equivalent to 2,000 ppb. In the more restrictive Alberta Ambient Air Quality Objectives (which are equal to or more stringent than existing National Air Quality Objective and Canada Wide Standards) is set to 53 ppb.

The Indoor Air study found no nicotine in the air of the chamber. When the researchers captured exhaled breath directly in a 7 liter glass chamber, they measured 0.007 milligrams of nicotine per cubic meter. The OSHA limit for exposure is 0.5 mg per cubic meter of air—71 times higher. “But the existence of this nicotine is a moot point,” stated Keller, “given the fact that the only way a bystander could be exposed to any nicotine whatsoever from vapor would be to lock lips with an e-cigarette user and inhale while the user is exhaling.”

“ANR would like the public to believe that manufacturers hide information about ingredients in e-cigarette liquid and vapor,” said Keller, “but the major ingredients in e-cigarette liquid are well-known: propylene glycol or glycerin to create the vapor, water, flavoring, and optionally a small amount (typically less than 2%) nicotine. Countless tests have been performed on liquid and vapor. So far none of these tests has ever measured toxins or carcinogens anywhere near hazardous levels. This is probably due to the fact that unlike conventional cigarettes, e-cigarettes are not combusted”

“Discouraging the use of alternative that are up to 99% less hazardous than smoking for the users, and that are essentially harmless to bystanders, shows an appalling disregard for human health and life on the part of groups like ANR,” said Keller.

Stanton Glantz is a liar (as if that’s news)

posted by Carl V. Phillips

Recently the Stanton Glantz, of the anti-tobacco activist organization that goes by the misleading name, “University of California San Francisco”, jumped fully into anti-THR lying.  Many of you will know Glantz as one of the most unabashed anti-smoking liars[*] in the world.

[*In fairness, unlike with some of the others featured in this blog, there is some debate about whether Glantz is knowingly lying or is just so clueless that the lie the fact he is claiming to be expert in the matters he is spouting off about.  There is also the possibility that he falls into the "so incompetent that he does not even realize he is clueless" category.  It is not clear which would be better.]

Glantz is the most aggressive pusher of absurd claims that small reductions in second hand smoke exposure (e.g., merely banning smoking in bars) result in 10% or 20% or even 40% reduction in heart attacks in the population.  That should perhaps be thought of as an final exam question rather than a serious claim:  If you think the claim is even remotely plausible, then you should have your diploma revoked — your high school diploma.

Glantz’s other favorite is claiming that if there were no smoking in movies then 50,000 or 100,000 or even 200,000 fewer American youth would start smoking each year.  I suppose someone might believe that and still deserve their diploma — but only if they were monastically home schooled.  Anyone who has actually spent time around teenagers and still believes that also fails badly.

In a recent blog post, Glantz referred to the German study that measured the gasses released into the air from e-cigarette use, the study whose conclusions Elaine Keller thoroughly debunked previously on this page.  Since we have already covered the debunking of the claims made by the authors, and showed that their results did not suggest there is a hint of a risk of hazard from “second hand vapor”, I will not repeat those points.  The previous post stands as a pre-debunking of what Glantz just wrote and thus is all the more embarrassing for him.  (Chances are he never read it; people like him have no interest in the truth, and so do not read to learn.)

I refer to you back to our debunking with this quote from Glantz’s statement:

putting detectable levels of several significant carcinogens and toxins in the air

Glantz — like the study’s authors — apparently does not realize that “so utterly trivial that it cannot possibly be viewed as being worth worrying about” is a subset of “detectable”.  In this case, that is exactly what was found.

But Glantz’s lies and errors were not limited to not understanding that the study helped confirm there is nothing to worry about.

there were still elevated levels of acetic acid, acetone, isoprene, formaldehyde and acetaldehyde, averaging around 20% of what the conventional cigarette put into the air

We have already covered much about this (hey! progress!) in previous posts with the tag “chemicals”.  Though, I am not sure we ever mentioned that more of that evil acetic acid he is so worried about is emitted by a salad than by an e-cigarette (most people call it vinegar).

To cover some new ground, consider that “20%” figure.  First, this is presumably intended to trick the reader into thinking that the trivial emissions from an e-cigarette are roughly 20% as bad as those from smoking.  But, these particular chemicals are not the ones that create much worry (whether well-founded or not) about environmental tobacco smoke.  It might also be that the emissions are about 20% of the exposure to those chemicals resulting from a nearby explosion of an artillery shell.  But that obviously does not make an e-cigarette 20% as bad as environmental artillery exposure.

But it is worse than that.  Let us imagine that the absurd falsehood that Glantz was (presumably intentionally) communicating were true, and that environmental vapor exposure were 20% as harmful as ETS.  Consider his conclusion (grammar muddle and incorrect reference to vapor as smoke in the original):

No one should smoke e-cigarettes indoors that are  free of other forms of tobacco smoke pollution.

This claim (the claim being the “should”) is obviously false.  If there is any rationality to no-smoking policies at all, then there are some venues where smoking clearly should be banned, but others where it is just barely on the positive side to have a ban (and, further along the spectrum are those where it is on the negative side to ban).  So if you now consider vaping, which produces virtually no aesthetic impact and only (even under this absurd hypothetical) 20% the risk from ETS, then clearly the venues that are just on the positive side for a smoking ban are not on the positive side for a vaping ban.

This is the most basic Economics 101 of honest and rational policy.  Of course, Glantz et al. are neither honest nor rational.  They are merely pushing any policy that inches toward prohibition.  But by pretending to be having an honest policy discussion, he opens himself up to honest policy analysis, and that analysis shows he is wrong (though probably merely clueless about what he is saying rather than lying in this case).

After receiving quite a few criticisms of his call for vaping bans by people with a better command of reality than his, Glantz responded to one observation, made by Elaine (and others too in other forums).  She pointed out, as in the previous post on this page, that the concentrations of the chemicals from exhaled vapor, even in a small unventilated space, were in the range of a fraction of 1% of the exposure limits that OSHA sets for workers.

Glantz, out of dishonesty or cluelessness, responded as if Elaine were saying, “these exposures sneak in under the OSHA limit and so that alone makes them ok”.  He argued that it is acceptable to expose workers to possibly mildly hazardous levels of chemicals because that is part of their job, and so exposure to bystanders should be held to a more restrictive standard.  His point is reasonable, but is not actually a response to the criticism.

Elaine was not saying “these are lower than the OSHA standards and that alone is what makes them unimportant”.  She was saying, in effect, “for those of you (basically everyone) who have no idea what these X ppb numbers mean, here is some perspective,” and saying, “this is so clearly below worrisome levels that OSHA allows more than 100 times that concentration before they require remedial action.”  So even if OSHA were allowing 10 times the harmful level (which they very much try to not do) there would still be a 10-fold margin before the measured exposure from vaping was harmful.

The absolute best part of this, though deserves its own post, but is a bit off-topic here, so I put it here.  If you found this interesting you will definitely want to read that.

Finally,

No one should have to breathe these chemicals, whether they come out of a conventional or e-cigarette.

What if they come out of an air freshener, which intentionally puts some of these chemicals into the air?  What if they come from a kitchen, a reliable source of some of them?  What if they come from cosmetics?

Oh, wait, those do not matter.  Glantz only pretends to care about these chemicals, or about people.  He only cares about cigarettes, and now apparently, about e-cigarettes.

But wait.  What if those chemicals came from Stanton Glantz?  After all, we have previously observed the vaper (i.e., a human body) seems to put out more formaldehyde than the vapor.  This applies to non-vapers too, including a puritanical busybody who is not smoking or vaping.  I think this is an utterly unacceptable health risk.  Moreover, having Glantz at large undermines efforts to denormalize junk science and dishonesty in the eyes of children.  Yes, I think it is pretty clear that we need to seal him up away from other humans.

Oh, and take away his computer too.  After all, letting him blog would also represent a dangerous exposure because….  Um, because….

Damn, I am just not as good at making up fake scientific claims as he is.

 

[UPDATE 27 Sept: More on the lies and liars on this topic at Dick Puddlecote.]

The passive vaping fable

posted by Elaine Keller (with input from Carl V Phillips)

Mr. Smith was delivering a speech across town in front of 800 people when the murder occurred. He had no blood on his clothing. Police could find no trace evidence at the scene that leads to Mr. Smith, and were unable to come up with a motive for the crime. Mr. Smith is a prime suspect.

The last sentence is a confounding conclusion. Not confounding in the epidemiologic sense – I will leave that topic to Carl – but in the sense of being baffling. It causes surprise or confusion because it acts against the reader’s expectations. When such conclusions appear in a murder mystery or puzzler, they can be entertaining. When they appear in scientific journal articles, they are perplexing. Or, in the spirit of this blog, they are lies.

Take the case of the paper published by German researchers on the subject of chemicals in electronic cigarette (e-cigarette) vapor.

Schripp T, Markewitz D, Uhde E, Salthammer T. Does e-cigarette consumption cause passive vaping? Indoor Air. 2012 Jun 2.

The final paragraph of the Conclusions section states,

“Overall, the e-cigarette is a new source of VOCs and ultra-fine/fine particles in the indoor environment. Therefore, the question of “passive vaping” can be answered in the affirmative. However, with regard to a health related evaluation of e-cigarette consumption, the impact of vapor inhalation into the human lung should be of primary concern.”

The reader is left with the impression that Schripp et al. found chemicals in e-cigarette vapor that would definitely endanger the health of users. The most likely way readers will interpret the phrase “passive vaping” is that the researchers found chemicals in the exhaled vapor that would be hazardous to the health of bystanders as well, given the fact that the CDC attributes 49,000 deaths each year to “passive smoking.”

The first rule of toxicology is “the dose makes the poison.” This means that it is important to know not only what chemicals are involved, but also the quantity of chemicals that are present. Almost any substance (even water) is toxic in large enough quantities and many “toxic” chemicals are harmless, or even helpful in some cases, in smaller quantities.

Fluoride is a good example of the first rule of toxicology. In concentrations of less than 0.5 percent in toothpaste, stannous fluoride and sodium fluoride helps strengthen teeth and prevent cavities. However, toothpaste overdose may cause stomach pain and possible intestinal blockage.

So what experiments did Schripp and his colleagues perform? There were two parts. The “large scale vaping/smoking experiment” was performed in an 8 cubic meter stainless-steel emission test chamber (about the size of the interior of American family SUV or minivan – with the windows up and the vents closed). A volunteer sat in the chamber and air quality was sampled after 20 minutes to establish a baseline. Then the volunteer was given an e-cigarette with one of three liquids: apple-flavored with no nicotine; apple-flavored with a nicotine concentration of 1.8%; and tobacco flavored with 1.8% nicotine. This was followed by a last trial, in which the volunteer smoked a cigarette.

For the large scale stainless steel chamber experiment, the researchers reported on the 20 compounds with the highest concentrations, comparing them to the concentrations at baseline. Fourteen of the 20 compounds that increased for the cigarette smoke showed no increase over baseline for the vapor of any of the three e-cigarette samples. The six compounds that did increase for vapor samples were 2-butanone (MEK), acetic acid, acetone, isoprene, formaldehyde, and acetaldehyde.

In their conclusions, the researchers failed to point out that many more compounds were found in smoke than in vapor, and they did not compare the quantities of compounds measured in vapor to those measured in smoke. The quantities measured in vapor ranged from 1/10th to 1/40th those generated by cigarette smoke.

Just how hazardous are the compounds in vapor? The Occupational Safety and Health Administration publishes permissible exposure limits (PELs) for hundreds of chemicals that might be present in the air at workplaces. Five of the six compounds were present in quantities that are less than 1% of the PEL. The sixth compound, formaldehyde, is produced naturally by the human body, and it was present at 2.4% of the PEL. If the researchers had provided this comparison in their data, it would have been obvious that their conclusions did not fit the facts.

Apparently the researchers were surprised at what they did not find. “Although 1,2-propanediol [propylene glycol] was detected in traces only within the 8 m³ chamber during the consumption of e-cigarettes, this compound must be released due to the visible fume in the exhaled breath. To determine the VOC composition in the breath gas directly, an e-cigarette smoker exhaled into a 10 L glass chamber.”  (Interestingly, this could be interpreted as them saying, “we changed our methodology on the fly because we did not like the results we were getting.”)

Perhaps they also were surprised that nicotine did not show up in their list of the 20 compounds with the highest concentration in smoke. Analysis of the immediately captured breath in the glass chamber resulted in a different list of chemicals than the stainless steel chamber experiment. The abstract states, “Prominent components in the gas phase are 1,2-propanediol, 1,2,3-propanetriol, diacetine, flavourings and traces of nicotine. As a consequence, ‘passive vaping’ must be expected from the consumption of e-cigarettes.”

The sequence of these sentences would lead the reader to believe that the chemicals specified in the first sentence lead to a condition they call “passive vaping” implying that it is similar in risk to “passive smoking.”

The extremely low quantities in the stainless-steel chamber experiment indicate that most of the chemicals found in concentrated captured exhalation disappear in the ambient air. For example, although nicotine was present (at 1.4% of the exposure limit) in the glass chamber experiment, no nicotine at all was detected in the stainless-steel chamber experiment. A bystander would need to lock lips with an exhaling e-cigarette user to be exposed to all the “prominent components of the gas phase” measured in the glass container experiment.

Even with the lip-lock, the highest level of chemical exposure in the second experiment (glycerin) is only 9.5% of the PEL. Two of the chemicals are not considered harmful at all. Not surprisingly, the highest concentration was for 1,2-propanediol, aka the non-toxic carrier, propylene glycol. If passive vaping is supposed to mean that bystanders are exposed to harmful levels of chemicals, then neither experiment in the study proved the existence of passive vaping.

Nothing in the perplexing conclusion to this article informs the reader about the extremely low level of danger represented by the quantities of chemicals detected. An accurate conclusion might have stated, “The consumption of e-cigarettes causes emissions of aerosols and VOCs, such as 1,2-propanediol, flavoring substances and nicotine, into indoor air; however the quantities of these substances are so low that they do not present a health hazard to bystanders or to the users themselves.”

Anti-Hahn poster

Today’s content is thanks to Kristin Noll-Marsh, who has created CASAA’s direct response to the Ellen Hahn poster that was the topic here for most of last week.  Taking a different tack from our letter to the University, Kristin created a consumer-friendly poster to directly compete with Hahn’s.  So anyone at or near the University of Kentucky, please print out some copies and post them next to Hahn’s!  Kristin’s document covers a lot of the same points that appeared here already, but it makes some additional points.  Moreover, even though it is a catchy poster, it also stands as more of a research paper (with specific sources cited for specific claims, in particular) than the blog — and probably more than anything Hahn has ever written.

Since it is all there at the link, I will not repeat it here.  (Aside:  Remember, the more links we have to the letter, poster, and blog posts, the higher those will be in searches compared to her lies.  Just sayin’.)

I know that a lot of readers are waiting for our response to the anti-THR press release about lung effects that was touted this week.  Since we have higher scientific standards than the author of that press release, it is taking a bit longer to finish.  It should appear in two or three parts starting later this week.

So, what is the point of Hecht’s latest press release?

posted by Carl V Phillips

I have been asked two very good questions about this topic:  (1) Is it really fair to treat Hecht as if his new claims reflect the same type of serial anti-THR lying found in Ellen Hahn?  (2) What exactly was the research that Hecht was touting in this press release?  The two questions are closely related, and one of them can be answered.

“This is the first example of a strong oral cavity carcinogen that’s in smokeless tobacco,” said Stephen Hecht, Ph.D., who led the study. “Our results are very important in regard to the growing use of smokeless tobacco in the world, especially among younger people who think it is a safer form of tobacco than cigarettes. We now have the identity of the only known strong oral carcinogen in these products.”

The answer to (1) is right there, in “…who think it is a safer form of tobacco than cigarettes.”  Out-of-control activists like Hahn might actually know very little about the relevant science they claim to be expert about, but Hecht has been at the center of anti-tobacco politics and research for many years.  There is no possibility he has failed to learn that smokeless tobacco is indisputably a safer form of tobacco than cigarettes.  Even in the unlikely event that he believes everything else he claims, the much lower risk of smokeless would still be obvious to him.  Perhaps his lies about the epidemiology, analyzed yesterday, could be seen as merely trying to puff up the perceived importance of his unimportant research rather than primarily being an active anti-THR effort.  But that “…who think…” lie is clear and obvious evidence of anti-THR activism disguised as science, which perfectly represents Hecht’s behavior over the years.

Notice also the “first” wording.  This is clearly meant to imply something like, “up until now, we were not really worried about smokeless tobacco causing oral cancer, but now we should look into it.”  The thing is, Hecht has been claiming that smokeless tobacco causes oral cancer for over a decade, claiming that the nitrosamines he has repeatedly reported on (particularly the chemicals known as NNN and NNK) were sufficient proof of that.  He has reported lab studies of basically the same thing, over and over and over again, and whatever the study result, his conclusions remained based on his politics.  His studies never changed the fact that the actual health science shows no measurable risk of cancer.  But that evidence never stopped Hecht from claiming that each of his non-new results provided new evidence that smokeless tobacco causes a high risk of cancer.

So what did he do this time?  It is very difficult to figure out because all we have is the press release.  Issuing a press release without making a working paper available is anti-scientific behavior in itself; even if everything presented were true, we are being asked to accept someone’s asserted conclusions without knowing their basis for those conclusions.  Some commentators focus on the lack of “peer review” in press releases, but this is really a red herring (peer review in health science is almost worthless — a topic for another day).  The real problem is the lack of information that would allow a reader to assess what was done and whether the methods and the conclusions seem reasonable.  All we actually know from the press release is that Hecht subjected rats to a mega-dose of a nitrosamine called (S)-NNN, presumably in a way that does not closely resemble smokeless tobacco use, though we do not know.  Some of the rats got cancer.

That is all we know.  We do not know what Hecht meant when he called this the first identification of a strong oral carcinogen in smokeless tobacco.  Is he admitting that his claims over the last decade about the other chemicals were lies?  Or are we supposed to conclude that “strong” has some subtle meaning, such that his previous claims were based on “non-strong” carcinogens and so he was not lying then about all of his claims then, but this is somehow different so he is not lying now about “first”?

Also we do not know how many trials Hecht ran, with how many different animals, with how many different chemicals administered in different doses and different ways, before he found a single result that made for good propaganda.  Actually, chances are we will never know that, even when this ends up in a journal.  When I said that toxicology was not inherently junk science, I glossed over the fact that this “hunt the carcinogen” branch of toxicology seems to have as its primary methodology, “keep doing ever-so-slightly different things until random error produces an outlier result for one trial, and then report on that result as if it were the only experiment that was done.”  That approach definitely qualifies as junk science.

The reader is not even told what (S)-NNN is, or how it differs from the NNN Hecht has been over-concluding about for years.  I could not easily find anything about it (e.g., it is not even clear whether this research represents Hecht discovering the chemical), though I am not a chemist so I might be missing something that the experts in that field could figure out.  But you know who are not experts in this entire area of chemistry?  Approximately everyone who reads the press release and the pseudo-news stories that resulted from it, who can thus be easily tricked by Hecht’s assertions.  All they came away “learning” were that Hecht and his ilk were not too worried about smokeless tobacco causing oral cancer last month, but based on this exciting new breakthrough, we should immediately take action.  More on that last aspect of the lies in the next post.