Author Archives: Elaine Keller

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.

Americans for Nonsmokers’ Rights shamelessly promotes continued smoking

posted by Elaine Keller

AUTHORS NOTE: This is Part 1 of 2. On September 26, the anti-smoker group, Americans for Nonsmokers’ Rights (ANR) issued a press release making false claims about e-cigarette vendors misleading the public about the safety of e-cigarettes and their efficacy for smoking cessation. CASAA has responded with a rebuttal press release (go read it, and then hit the tweet etc. buttons to raise its profile!).  Our rebuttal had to be drastically shortened for the press release version, however, so here we share the original. Today’s post addresses the smoking cessation issue. Tomorrow’s post will address the ANR’s misleading statements about the safety of vapor.

SPRINGFIELD, VA, October 1, 2012

–Americans for Nonsmokers’ Rights (ANR) and other proponents of the extremely ineffective abstinence-only approach to smoking cessation are misleading the public about hazards of electronic cigarettes through paid press releases, social media, and even scientific publications and conferences. A recent press release by ANR also falsely claims that there is “a lack of independent peer-reviewed scientific evidence demonstrating the safety or efficacy” of electronic cigarettes for smoking cessation.

The problem with their preferred abstinence-only approach is simple: It doesn’t work. Every medically-approved method of smoking cessation is based on becoming 100% abstinent from any form of nicotine. FDA-approved nicotine patches, gum, lozenges, nasal sprays, and oral inhalers are referred to as Nicotine Replacement Therapy (NRT) products, but all these products are accompanied by directions to gradually reduce the daily intake of nicotine to zero.

A study published in 2003 found that in the real world, over-the-counter NRT has a 93% mid-year failure rate. A 2012 study conducted by researchers at the Harvard School of Public Health and the University of Massachusetts found that the relapse rate was the same for those using NRT as those who had not, regardless of whether they received counseling support.

In contrast, a growing body of scientific evidence is showing that providing smokers with a low-risk alternative such as electronic cigarettes is a much more effective way than nicotine-abstinence to achieve abstinence from smoking.

BMC Public Health is a peer-reviewed scientific journal that published the results of an Italian pilot study in November, 2011, that monitored modifications in smoking habits of 40 smokers unwilling to quit, hoping to see a reduction in the number of cigarettes per day (CPD) smoked. The researchers were pleased to observe a 50% CPD reduction in 32.5% of subjects and an 80% reduction in 12.5% of subjects. But they were astonished to discover that at the end of the 6 month study, 22.5% of these unwilling-to-quit subjects had completely stopped smoking.

Among smokers that want to quit, the results are even more remarkable. Another peer-reviewed scientific journal, the American Journal of Public Health published the results of an online survey of first-time buyers of a particular brand of e-cigarette. The 6-month point prevalence smoking abstinence rate was 31% among this group.

In June 2011, the peer-reviewed medical journal, Addiction, published the results of an internet survey of over 3,500 e-cigarette users who used a variety of brands and nicotine strengths. The survey found that 77% of daily e-cigarette users had become former smokers.

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.


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.”