by Carl V Phillips
I have several posts worth of material to cover on the themes presented here. I’ll see if I can get to them. In the meantime, some random thoughts about the third FDA Center for Tobacco Products workshop on e-cigarettes that took place on Monday and Tuesday of this week. As with the previous workshops, it was a mixed bag of good science from industry and a few others, sneaking in amidst the utter junk from the “public health” types. At this one, the mix was perhaps almost up to 50-50, which is a lot better than the previous ones.
The agenda is here. I am not going to attempt to summarize the content or even systematically address the high points in the blog, but rather just highlight a few important points. You can read through my live blog at the CASAA members Facebook page if you want a summary of the whole thing (day 1, day 2). It should be readable; I tried to write the play-by-play bits so that they are readable as an extremely abbreviated summary for non-live readers, though I cannot say I am sure that was successful. The conversational among participants who were watching the presentation may or may not make sense, though I tried to go back and delete the comments that were wholly dependent on references to what had just been viewed for ease of future reading.
So finally, after CASAA submitted multiple applications for presentations at each of the workshops — for me and Igor Burstyn for both, and one other also — we finally managed to get a moment on the podium on behalf of consumers. They still refused to allow us to present our research, rejecting it in favor of the utter garbage that was presented, but at least I got to speak on the final panel of the session. You can view the panel I was in via this link (you have to register and that will give you access to the replay) starting at 2:14. I would not normally recommend people take the time to watch video, but if you like what I write I think you will like what I said. Also, those of you trying to watch it live missed half of it (the live feed of the meeting failed halfway through my panel, which several CASAA members attributed to them wanting to hide what I was saying, though incompetence is always a more likely explanation). Being a panel it it includes others, of course, and much of it was about the talks they gave in the session that came before, but it probably will mostly make sense if you just read the titles of their talks in the agenda.
If you do not watch it, you can at least read what I read for my mandatory conflict of interest statement. Never pass up a chance to use a conflict of interest statement to make a statement.
I am Carl V Phillips. My research has focused on tobacco harm reduction for 15 years, first as a professor and now with CASAA. I am here under the auspices of CASAA, which represents its 60,000 members and other consumers and would-be consumers of low-risk tobacco products; this is not a conflict of interest because consumers are the one group whose interest is to understand — without spin or hype — the real health effects of the products.
I should note that this marks the first time at any public meeting in the history of the Center for Tobacco Products that a representative of the primary stakeholder, the consumers, has been given a seat at the table. This appears to be a small step in the right direction, though since I am here in my role as scientific expert rather than consumer advocate, it is not clear whether this really should count.
In terms of my own funding outside of CASAA, at one time or another I have received research grants or consulting contracts from most every sector with a financial interest in this matter. This includes companies that sell e-cigarettes. It also includes those that benefit from sales of competing products: pharmaceuticals, smokeless tobacco, and cigarettes. In particular, I have received funding from those who profit the most from the sales of cigarettes — that, or course, being the governments of the United States and other jurisdictions — as well as those who manufacture those products.
Probably the most interesting thing that came out of the meeting was the various studies that showed that the “second-hand” exposure is even more trivial than we already knew. It appears that about 98% of nicotine is absorbed by the vaper (for normal vaping behavior — cloud chasing is a different story), and it does not much matter whether you hold the vapor in. It turns out that holding your breath for a few seconds matters if you want to avoid creating any visible exhalate, but really does not change the nicotine delivery. Indeed, even when a vaper allows some visible exhalate, most of the PG and glycerol, and presumably most of the trivial quantities of other chemicals, are also absorbed. This means that the bystander exposure is going to be many orders of magnitude less than the vaper’s exposure (which causes no known health effects). The quantities in the entire room someone is vaping in are almost two orders of magnitude less than what the vaper absorbs. Since someone else in that room is going to breathe only a tiny fraction of that air, actual exposure is orders of magnitude less than that. So rather than the three orders of magnitude less exposure than the vaper that Burstyn estimated, we should probably be thinking in terms of a worst case scenario of four orders (i.e., less than 1/10,000th the exposure).
To appreciate my joke from the panel discussion, if you choose to watch that, you need to know that the exception to those results was one complete wackadoodle presenter, a freelance environmental testing guy from San Francisco, who was presenting a bunch of nonsense conclusions about something he did (yes, “something” — he never explained his methodology) and claiming there was some dire risk to bystanders. He also practically filibustered the panel discussion from his session, even though it contained several real scientists with useful contributions to make, and yet he still never managed to explain what he was claiming. I assume FDA included him in order to make sure their pet “researchers” — the highly practiced liars — looked credible by comparison.