Tag Archives: “passive vaping”

Cheryl Healton lies (a lot!) to try to get NYC to restrict ecigs

by Carl V Phillips

This analysis, of this blog post, might seem a little more brutal than usual.  That is because the author, Cheryl Healton (the former head of the leading anti-tobacco organization, American Legacy Foundation — a fact that is omitted in the introduction of her in the blog in question — and now head of the public health program at NYC), knows the truth.  This is not a case of someone who is too innumerate to not know she is lying, or a useful idiot that is being used by the anti-tobacco extremists.  Healton is one of the puppet masters who manipulates her useful idiots (like New York Assemblywoman Linda Rosenthal), which she is doing in this post.  Notice in particular the many times that she lies by using literally true but highly misleading statements, the mark of someone who knows she is lying but wants to be able to pretend otherwise.

The post appears in the blog of the “NYC Coalition for a Smoke-Free City”, an obviously misnamed group since they are campaigning not against smoke, but against e-cigarette use.  The thesis is that NYC should go ahead with its proposal to prohibit e-cigarette use anywhere that smoking is prohibited.  It is remarkable how close Healton comes to lying in every single sentence.  The first few about the fact that NYC is about to act on this are true, but most everything that follows is a lie:

Who is the e-cigarette industry?  Increasingly the e-cigarette industry is owned by the tobacco industry, an industry that would not be permitted to exist were it invented tomorrow because it would violate the consumer protection laws of all states and virtually every country in the world.

As I have pointed out, this “would not be allowed to exist” claim is at best pure speculation, and probably wrong.  But apart from that, it refers to a product (cigarettes), not an industry.  If the industry came into being right now selling low-risk products like smokeless tobacco, e-cigarettes, and NRT (all of which are sold by “the tobacco industry”), it would be allowed to exist.  But, of course, this soup of words is not meant to analyze the actual claim, but to lie about e-cigarettes, suggesting they are some industry plot.  In case the innuendo is lost on the reader, she goes on to lie,

For this reason, a healthy degree of skepticism about the industry’s ultimate goal in buying up e-cigarette manufacturers and creating more “efficient” e-cigarettes should prevail as policy makers establish regulations governing them. It is quite possible that the net effect of e-cigarettes will be to induce greater youth initiation of smoking and reduce the adult cessation rate, but the jury is still out.

I cannot imagine that Healton is stupid enough to actually believe that.  It is impossible to come up with a story to explain why the existence of e-cigarettes (let alone the acquisition of a few companies that she led into that with) could cause smoking at all, let alone to cause a net increase in smoking initiation.  E-cigarettes, like any popular low-risk alternative, will replace smoking initiation, not cause it.

Both youth and adult smoking rates are at their lowest levels in decades, so much is a stake for the health of the public.

Setting aside the fact that the “so” is a non sequitur, is what she is saying is that having almost 20% of the population smoking is such a success that harm reduction should be avoided?  It appears so.

There is also much at stake for the tobacco industry as it seeks to apply its considerable marketing acumen and seemingly endless resources to maximize profit by increasing the number who start smoking by enticing youth worldwide to smoke and by trying to retain current smokers.

Complaining about “endless resources” is pretty funny coming from someone who is at the apex of the billions-per-year tobacco control industry.  But the real question is what this passage has to do with e-cigarettes at all, let alone restricting where you can use them.  It is typical tobacco control misdirection:  “Cigarette manufacturers profit from more people smoking and remaining smokers, and therefore we should restrict where people can use e-cigarettes.”  Huh??!

Who might be hurt by e-cigarettes?  The tobacco products the industry has historically manufactured and promoted as “reduced harm” are not benign products created to meet the broad range of consumer preferences in the United States, rather they are deadly products that when used as directed kill over 400,000 Americans each year and are predicted by the World Health Organization to kill a billion people worldwide this century, 10 fold more than they killed in the 20th century. To put the scope of the current tobacco-related epidemic in perspective, in a few years, global lung cancer deaths will surpass AIDS deaths as the steady march of tobacco industry marketing continues to engulf the world’s poorest nations.

Again, huh??!  Does anyone see any connection between that question and what follows?  (Yes, I realize that the reader might now be questioning my assertion that Healton is too smart to not know she is lying.)  Her allusion to historical products is the usual tobacco control canard about the introduction of “light” cigarettes four decades ago, products where there was no evidence to suggest they would be lower risk.  And yet they were actively endorsed by the public health community, not just the manufacturers.

However, a mistake by everyone a couple of generations ago about what might be lower risk tells us nothing about the present world of products that are known to be lower risk.  It is an utterly absurd and blatant lie to suggest otherwise.

None of what she says in this paragraph is true about the actual reduced harm products that have been introduced by the tobacco industry and by others.  Smokeless tobacco, e-cigarettes, and other low-risk products do not cause the harms she is citing; cigarettes do.  (Well, cigarettes cause and will cause a lot of harm, though not as much as she claims.  But that is another story).  She seems to be trying to invoke the conjunction lie, that cigarettes plus low-risk alternatives do that much harm (which implies the harm is shared, even though it is basically all caused by cigarettes), but she screws up doing even that.  She actually is claiming that the low-risk products alone cause all the harm from smoking.

Nicotine addiction is in and of itself a gateway to tobacco product use because once addicted many will broaden the products they use and included among these will be the most dangerous products like cigars, cigarettes and hookah.

It is true that people who like to use one tobacco/nicotine product often try other products.  But what she is trying to imply (carefully avoiding actually saying it) is that using e-cigarettes will cause people who would not have otherwise smoked to do so.  There is no reason to believe this would be the case, and certainly no evidence of it occurring.

And it is worth pausing to remember that the title of this post says that NYC should include e-cigarettes in its smoking place restrictions.  I have skipped a few sentences but have not left out anything that addresses that.  There has been nothing yet.  Even if the previous quote were not a lie, it would still only be an argument against letting kids use e-cigarettes, not about forbidding adults from using them at their desks or in bars.

Most tobacco-related deaths are the culmination of substantial suffering and societal cost from heart disease, emphysema or various cancers and are the direct result of nicotine addiction.  Moreover, nicotine addiction is considered by many scientists as the most intractable of all addictions as measured by the percent of ever users who become addicted and the percent who remain addicted until death. Half of lifelong smokers lose their lives to tobacco addiction and among these people nearly half die before retirement age.

A pretty good argument in favor of encouraging e-cigarette use.  The bit about “most intractable” is nonsense, of course.  The reason users have more incentive to quit, say, meth than to quit smoking is the high level of short-term damage it is doing them.  And the “half” is a made-up number that is higher than what the evidence suggests.  Most important is that claims about the “addictiveness” of smoking tells us little about e-cigarettes, given the evidence that e-cigarettes are much easier to quit.

And, once again, this has nothing to do with whether there should be a place ban on e-cigarettes.

E-cigarettes are a complex product and their availability and the regulatory framework for governing them may have different implications and considerations for youth non-smokers compared to adult smokers. E-cigarette policy could produce sharply differing results by population sub-group.  Data demonstrate that a significant swath of adolescents already are using e-cigarettes. Time will soon tell whether e-cigarettes function as one more point of entry to cigarette, cigar and hookah consumption among those using e-cigarettes initially. One thing is clear however, since cessation efforts have thus far not worked with teens, e-cigarettes will likely not do anything good for kids and may well entice many to start smoking in view of the broad array of sweet, candy flavors and slick e-cigarette marketing already blanketing the internet, mall kiosks, TV and radio, which have to date eluded regulation.

Blatant lies and clueless nonsense.  (Ok, I will admit I am starting to doubt my previous assertion that Healton really understands what she is saying.)  Skipping past the distractions that the first few sentences comprise, we have the lie that many adolescents are using e-cigarettes, a repeat of the lie that there is any reason they would cause smoking, the lie that because other cessation efforts do not work for kids that harm reduction will not work for them (it might be true, but probably is not, and it is nothing more than speculation asserted as fact), and of course the usual canard about marketing.  Once again, the biggest lie here is that this has anything to do with restricting where adults can use e-cigarettes, or anything else about adult use.

Whether e-cigarettes will offer an incremental boost to cessation rates nationally also remains to be seen.

No, it doesn’t.  Close to every e-cigarette user is either a former smoker or a current smoker who has replaced some smoking with e-cigarettes and could be persuaded to complete the transition.  Many of those who quit smoking report that they had not been able to succeed at cessation until they tried e-cigarettes, and only then did they quit.  Therefore e-cigarettes have increased cessation.  This is not really a difficult concept to understand.  (She goes on in that paragraph to lie about what the research shows, but I will stop at debunking her thesis claim.)

This is the epitome of the ANTZ tactic of declaring every negative they can concoct to be a real concern, even if there is zero evidence and even if the evidence clearly shows it is a non-issue, while denying every positive by pretending that the evidence does not exist.

We should also remain open to another highly plausible effect of e-cigarettes-that they will function in the same manner “light” cigarettes did when they were introduced in the 70′s, promoted by the tobacco industry as a step smokers could take to feel safer without actually quitting smoking. As many subsequent studies showed, in fact they were not safer and millions who would have quit had they not been introduced failed to do so costing innumerable lives.

And (setting aside the lies about “light” cigarettes themselves) there is that lie about the situations being similar again.  The obvious difference is that e-cigarette users are “actually quitting smoking”, unlike light cigarette users, and they are using a product that genuinely is low risk.  What does a public health failure of the 1970s have to do with e-cigarettes?  Absolutely nothing.  It is basically the same as saying leeches turned out to be harmful rather than helpful in treating infectious diseases, and therefore we should avoid antibiotics.

Do we really want everyone vaping where they once could smoke?  

Oh, look, she is finally addressing the question she claims to be addressing.

The proposed extension of the SFAA to e-cigarettes, which will be voted on tomorrow, also will reduce the “walking billboard” effect of thousands of New Yorkers once again lighting up in bars, subways, parks, office buildings and restaurants throughout the city. But banning e-cigarettes in some locations solely for this reason is un-American in a country that prides itself on maximizing the freedom of its adult citizens to choose to engage in a range of risky and frisky behaviors. 

Interesting.  It is not a very risky behavior, of course, but it is nice to see that New York is still part of America.

The “billboard” claim is utter nonsense, of course.  How is someone vaping in their office, rather than outside the front door, a billboard?  E-cigarettes could still be restricted on the subway and restaurants could make their own choices about what is best for their patrons and vibe.  The proposed ban would eliminate all discretion, reasonableness and common sense, going beyond a few specific restrictions that some might argue are reasonable and imposing rules that are clearly absurd and harmful.

Take a step back and see what she is doing with all of this.  She is appealing to people who are worried about kids using e-cigarettes and do not like people vaping on the subway, and trying to trick them into supporting a rule that bars cannot choose to allow their patrons to vape.  If she actually cared about kids and subways, she would propose something that affects kids (this rule would not) and would endorse a rule that just applies to the subways (which could probably be done by administrative fiat).  Notice she never once offers any reason why banning vaping in bars, private offices, and many outdoor spaces would do any good for anyone, and indeed tries to hide the fact that this regulation would impose such restrictions.  Classic tobacco control bait-and-switch.

It should be noted, however, that while we in general embrace this ethos, when it comes to public drinking we often do not. We do not embrace wandering down the street drinking a cocktail, hopping into the elevator rum and coke [sic] in hand or whipping out a flask of whiskey on a plane.

Ok, so no vaping on elevators and planes.  I suspect that even most dedicated vapers would not find those to be terribly unreasonable restrictions.  As for walking down that street, the street would be one of the few places vaping was still allowed under the restrictions.  The anti-THR people cannot even keep their own stories straight.

Do we know enough to allow vaping in public spaces?  So what are the real risks of public vaping? Is it as its promoters would like us to believe a benign, reduced harm practice that is at worst a passing fancy?

Um, no.  Its promoters think it is here to stay.  Also, the ban is mostly about private spaces, not public spaces.

Or is it a potentially toxic practice that places those in its immediate vicinity at risk. The answer is we do not completely know yet, although already studies have shown elevated nicotine levels among those exposed to secondhand vaping, and this in and of itself is ominous. Not definitively measured as yet among second hand vapers [sic] are the myriad other toxic substances which are contained in e-cigarettes. 

Cute, huh, that use of “completely” and “definitively”.  Of course we know, from ample evidence, with a very high degree of certainty that the risk to bystanders is zero or utterly trivial.   But we never know anything completely or definitively.  Someone can always use weasel words like that to intentionally trick the reader into thinking she made a statement about what we really know, rather than merely a statement about the fact that there is never proof or complete information in the real world.

And if anyone is aware of any study that shows elevated nicotine levels from people exposed to “secondhand vapor”, I would be quite interested in hearing about it.

Under these circumstances, the prudent course is to extend the SFAA to encompass e-cigarettes until, if ever, sufficient evidence exists demonstrating their safety.

Right.  And what might that be?  Oh, you say, no evidence would ever be sufficient for that.  Thought so.

And why exactly would this be prudent?  I do not think that word means what she thinks that word means.  Is it prudent to restrict a very personal freedom when there appears to be no reason to do so, just because such a reason might be found later?  (Sounds like an argument for banning, say, the building of mosques in America — there are many who would make the same “we just don’t know if this will hurt the children” arguments about that.)  Is it prudent to ensure that cigarettes remain as attractive as possible as compared to low-risk alternatives?

The only conceivable downside of not extending the SFAA to e-cigarette use is the loss of any incremental harm reduction for smokers associated with being permitted to smoke e-cigarettes in locations where smoking is now banned.

TrANTZlation:  The harm it would inflict on those not able to vape at their desk, in bars, etc. is of absolutely no consequence.  We are tobacco control.  We don’t actually care if tobacco users suffer.  In fact, we prefer it.

And, of course, making e-cigarette use less attractive creates the public health harm of encouraging smokers to keep smoking.

It is highly unlikely that such a benefit, if it in fact exists, would outweigh the harms to youth, to non-smokers exposed to vaping nicotine laden vapors and potentially other toxins, and to recovering smokers who now stay quit in part because smoking has become less ubiquitous than it was 50 years ago when the Surgeon General released the first report on Smoking and Health.

Huh?  It is highly unlikely?  Care to quantify?  I would love to hear about the harms to youth from people vaping at their desks.  What harms are caused by (barely) “nicotine laden vapors”?  What possible impact is there on “recovering smokers”?

Sadly e-cigarettes may lead to four negative outcomes: the initiation of more youth to nicotine dependence and subsequent conventional smoking; the use of e-cigarettes by current cigarette smokers who would otherwise have quit but instead use both conventional cigarettes and e-cigarettes in combination and therefore delay quitting or never quit and; the relapse to smoking by those who have already quit, first to smoking “benign” e-cigarettes and then to conventional cigarettes; and the exposure of people to e-cigarettes’ emissions unknown risks.

And how does all of this other than the last bit (a lie that has already been addressed) relate to the question at hand?

Who loses, if anyone, by extending the SFAA to e-cigarette use? Virtually no one loses. Vapers can still smoke everywhere current smokers now do. Let’s do what NYC has become known for and enact a policy that saves lives, not costs them.

Just in case the above trANTZlated passage was not clear enough, here she comes right out and says that the hardships suffered by vapers as a result of the rule do not matter.   Smoking place restrictions are designed to make smokers less happy — tobacco control advocates generally admit that these days — so obviously imposing the same restrictions on vapers will make them less happy too.  I wonder if it is a Freudian slip when she says that “vapers can still smoke” — because that is exactly what will happen:  Some would-be vapers, upon having to go out to the smoking areas anyway, will indeed smoke.  As a result, some of them will die from smoking and their blood will be on the hands of liars like Healton.

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.]

North Dakota’s Lies Freeze Out Smokers and Former Smokers

posted by Elaine Keller

On November 6, North Dakota citizens will vote on adopting a drastically revised version of the state’s anti-smoking law, “Initiated Statutory Measure No. 4 Relating to Prohibiting Smoking in Public Spaces and Worksites.” Absentee balloting has already begun.

Chelsey Matter, a West Fargo respiratory therapist, served as chairwoman for Smoke-Free North Dakota’s sponsoring committee for the initiated measure which required 13,457 signatures on a petition to place the measure on the ballot. SFND appears to be an ad hoc committee made up of members of various anti-smoker groups. Notice that I labeled the groups “anti-smoker” rather than “anti-smoking”

At one time, such groups claimed they were only concerned with protecting the health and safety of bystanders. Now it is clear that the goal is much broader. Their “denormalization of smoking” really means the “demonization of smokers.” And if smokers are demons, it’s OK to punish them, in some of the worst possible ways, even after they have stopped smoking.

The ballot item reads as follows;

Initiated Statutory Measure No. 4

This initiated statutory measure would amend chapter 23-12 of the North Dakota Century Code. This measure would prohibit smoking, including the use of electronic smoking devices, in public places and most places of employment in the state, including certain outdoor areas. It would provide notification and enforcement responsibilities, along with penalties for violations.

YES — means you approve the measure summarized above.
NO — means you reject the measure summarized above

The ballot language itself and the propaganda issued by the anti-smoker groups that initiated the measure contain some blatantly false claims as well as implied false claims.

FALSE CLAIM 1: Workers currently have no protection against smoke in the workplace.

Supporters claim the ballot measure is needed “to assure smoke-free air for all workers and most public places,” implying that most or all North Dakotas have no clean air in which to work.

THE FACTS: North Dakota’s Century Code is the codification of all general and permanent law enacted since statehood. Under the current law, Chapter 23-12-09, “Smoking in public places and places of employment,” smoking is prohibited in all enclosed public areas, with few exceptions.

FALSE CLAIM 2: Electronic cigarette vapor is identical to conventional cigarette smoke.

The proposed new version of the law adds “e-cigarette” to the definitions section and revises the definition of “smoking” to imply that vapor is the same thing as smoke.

THE FACTS: A recent study published in Indoor Air compared exhaled smoke to vapor. In vapor they could detect only 6 of the 20 highest concentrations of chemicals found in smoke.

The amounts of the six chemicals measured in vapor could be expressed as whole numbers only by converting to parts per BILLION (ppb). All were far, far below harmful limits. For example, formaldehyde was present at the equivalent of 13 pennies out one billion (ten million dollars worth of pennies.) The Alberta Ambient Air Quality Objectives for formaldehyde is five times higher.

Furthermore, since vapor is not produced by the process of combustion, it does not contain the harmful tar, carbon monoxide, particulates, and thousands of chemicals found in smoke. A U.S. Federal Court judge told the FDA that there is “no evidence to show that electronic cigarettes harmed anyone.”

FALSE CLAIM 3: Vapor exposes bystanders to the dangers of nicotine.

An opinion piece written by one of the measure’s proponents stated, “… there is no study that shows what a safe level of nicotine is and, personally, I don’t believe there is one.”

THE FACTS: Nicotine may be the least harmful of any of the ingredients in smoke. But even if it were more dangerous, the point is moot, because exhaled vapor does not expose bystanders to nicotine. In the Indoor Air study, researchers could detect nicotine only by capturing exhaled vapor before it mixed with air in the chamber.

The quantity of nicotine measured was a mere 1.04 ppb; the OSHA Short Term Exposure Limit is about 1500 times higher.  And the only way a bystander could come into contact with this tiny, tiny amount would be to lock lips with an e-cigarette user as he or she exhales.

FALSE CLAIM 4: E-cigarette users are trying to get around anti-smoking laws.

The revised definition of ‘smoking” claims that e-cigarettes are used for the purpose of “circumventing the prohibition of smoking in this Act.”

THE FACTS: The only way someone can be “circumventing the prohibition” of any action would be to actually be doing the prohibited action. Using an e-cigarette is not smoking. In fact, most e-cigarettes are former smokers who use the devices to avoid relapsing to smoking.

FALSE CLAIM 5: The new law will protect health and improve the economy.

According to a news item, Matter says the Smoke-Free North Dakota committee decided to move forward because of the positive health and economic impact a smoke-free law would have on the people of North Dakota.

THE FACTS: The measure will endanger the health of many people and negatively impact the hospitality industry.

Banning the use of e-cigarettes indoors endangers the health of former smokers who may be tempted to relapse if sent out into the elements with the smokers. Many smokers first discover the safer devices when they see them being used where smoking isn’t allowed. Banning indoor use removes an incentive for smokers to switch to a low-risk alternative.

The measure removes exemptions for bars, outdoor stadiums, tobacco shops, private rooms in hotels and motels, and private nursing home rooms. California Governor Jerry Brown recently vetoed a nursing home smoking ban, stating it would be “reasonable to allow elderly smokers to remain inside during inclement weather.”

The measure does not allow hotels and motels to set aside some designated rooms for smokers. If this measure is passed, North Dakota will provide no overnight shelter for smokers (and users of smoke-free e-cigarettes) outside of private homes.

The law will change the definition of “enclosed area” to prohibit smoking in most designated outdoor smoking areas. The original definition was meant to apply to indoor areas only.

“Enclosed area” means all space between a floor and ceiling that is enclosed on all sides by solid walls or windows, exclusive of doorways, which extend from the floor to the ceiling.

To be exempted from inclusion in the definition of “enclosed area” where smoking is prohibited,  outdoor shelters would provide inadequate protection from the elements.

“Enclosed area” means all space between a floor and a ceiling that  has thirty-three percent or more of the surface area of its perimeter bounded by opened or closed walls, windows or doorways. A wall includes any physical barrier regardless of whether it is open or closed, temporary or permanent, or contains openings of any kind, and includes retractable dividers and garage doors.

Many businesses made a considerable financial investment in constructing and heating shelters to protect the health of their employees and their patrons.

In Norse mythology, Hell is a cold, freezing place. Sending paying hotel guests, restaurant patrons, sick people, and former smokers out in the elements is downright rude. But given the nature of North Dakota winters sending anyone outside and simultaneously reducing the size of shelters to less than 33% walls could be life-threatening.

Public health officials may have a responsibility to reduce the smoking rate, but nobody gave them the authority to accomplish it by hastening the demise of smokers.

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.”