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E Cigarette Interview with Professor Riccardo Polosa

I think that e-cig is a good solution to reduce the use of traditional cigarettes and their associated risk. Other valid options for tackling nicotine dependence in smokers exist, but it is still a personal choice how to introduce nicotine in his/her body. Each individual smoker should find a best way to reduce or eliminate his or her own smoking. In theory, at least for westernized cultures, vaping is a far better option than smoking. And it could save millions of lives.

Polosa (2011)


Doctors favour junkies over smokers

… there’s a stubborn portion of the population that is hard-core addicted to nicotine and that rather than writing them off or pretending that lecturing them will make them kick, our public health is better off by working to minimize the risks their addictions pose to their health and safety. And there are ways to do that. Promoting smokeless tobacco is a big one, since so much of the mortal danger that nicotine addicts risk comes from the carcinogens in smoking. E-cigarettes, or tobacco vapourizers, are another major improvement over smoking. And in Sweden, where millions of smokers have switched to a under-the-lip pouch of tobacco called snus, lung cancer rates and heart disease rates have fallen to some of the lowest in Europe. Just as with Insite, there is solid evidence showing that these lower risk products lead to increases in public health.

Libin (2011)


Could E-cigs become the ultimate nicotine maintenance device?

E-cigs should be allowed to compete for the middle ground between highly toxic smoked tobacco products and smoking cessation medicines that have been demonstrated to be safe and effective for that purpose. Thus e-cigs are currently competing for the smoke-free nicotine maintenance market, primarily against other smokeless tobacco products such as snuff, snus and dissolvable tobacco products. How successful they are in competing in that market-place will depend upon whether manufacturers can mass-produce and market relatively low-cost, safe, reliable and user-friendly products with adequate nicotine delivery. They should be regulated to ensure that they do not deliver toxic chemicals unnecessary to their purpose (e.g. quality control measures should ensure no contaminants are in the liquid or vapor), and are as safe as technically possible (e.g. liquid should be in a child-proof container, and instructions for use should be clear and accurate).

Foulds and Veldheer (2011)


Electronic cigarettes as a method of tobacco control

… health professionals should be able to suggest to smokers who are unable or unwilling to use or continue to use effective aids to quit, and who are interested in e-cigarettes, that these are a better option than continuing to smoke. And although it is better not to use any form of nicotine long term, if patients must, e-cigarettes are a lower risk option than continuing to smoke.

Borland (2011)


… products that deliver nicotine quickly in a ine vapour instead of as harmful smoke could prove an effective substitute for ‘conventional smoking’. It will be important to get the regulatory framework for these products right, to encourage new products, which smokers can use as safer nicotine alternatives, to be made available in the UK. A tenet of behaviour change is that it is much easier to substitute a similar behaviour than to extinguish an entrenched habit (an example was the rapid switch from leaded to unleaded fuel). If more alternative and safe nicotine products can be developed which are attractive enough to substitute people away from traditional cigarettes, they could have the potential to save tens of thousands of lives a year

UK Government Behavioural Insights Team (2011)


E-Cigarettes – No Toxic Effects from Inhaled Propylene Glycol Aerosol

… even high concentrations of PG vapor don’t have any measurable harmful effects, which is fully consistent with its designation by the FDA as “generally recognized as safe” as a food additive for all food categories up to 2% (here). Just as important, there will be no impact on bystanders from “second-hand” exposure to e-cigarette vapor, if it occurs at all.

Rodu (2011)


Anti-smoking groups have also discounted warnings regarding the life-threatening effects of Chantix and thus find themselves in the absurd situation of calling for a ban on electronic cigarettes, which have killed no one, while promoting the continued availability of Chantix, which has been associated with more than 200 suicides.

Siegel (2011)


[electronic cigarettes] have received the thumbs up from Quitline, an incorporated charitable trust committed to helping New Zealanders quit smoking.

Chief executive Paula Snowden said electronic cigarettes were a much safer option for dispensing nicotine than smoking .

“It’s the smoke that kills you; taking nicotine without the smoke is a much safer option. Nicotine isn’t harmful on its own.”

Quitline (2011)


E-cig were used mainly by former smokers, much as NRT, as an aid to quit smoking, avoid relapse, deal with craving
E-cig were perceived as efficacious, useful, satisfactory
Almost all users preferred nicotine-containing e-cigs
E-cig provide high amounts of nicotine (as reflected by cotinine)

Etter & Bullen presentation (2011)
[Nobody seems to have told them that nicotine liquid tastes vile]


I would like to see smokers have more access to things like this, alternatives that are safer … We’ve got to get people off the cigarette smoke.

Glover – Director of Auckland University’s Centre for Tobacco Control Research (2011)


The issue of harm reduction has long been controversial in the public health practice of tobacco control. Health advocates have been reluctant to endorse a harm reduction approach out of fear that tobacco companies cannot be trusted to produce and market products that will reduce the risks associated with tobacco use. Recently, companies independent of the tobacco industry introduced electronic cigarettes, devices that deliver vaporized nicotine without combusting tobacco. We review the existing evidence on the safety and efficacy of electronic cigarettes. We then revisit the tobacco harm reduction debate, with a focus on these novel products. We conclude that electronic cigarettes show tremendous promise in the fight against tobacco-related morbidity and mortality. By dramatically expanding the potential for harm reduction strategies to achieve substantial health gains, they may fundamentally alter the tobacco harm reduction debate.

Cahn and Siegel (2011)


Electronic nicotine delivery systems: a research agenda

… the first priority is to characterize the safety profile of these products, including in long-term users. If these products are demonstrated to be safe, their efficacy as smoking cessation aids should then be tested in appropriately designed trials. Until these studies are conducted, continued marketing constitutes an uncontrolled experiment and the primary outcome measure, poorly assessed, is user health.

Etter, Bullen, Flouris, Laugesen and Eissenberg (2011)


As the e-cigarette delivers only nicotine in a mist of propylene glycol, without the other 4,000 or so other chemicals in tobacco smoke, it is far safer than smoking.

The risks to smokers of pure nicotine, delivered in doses seen with the e-cigarette and NRT products, are extremely low. Animal studies suggest that the use of long-term (20 hours a day, five days a week during a two-year period) inhaled nicotine is safe.

In animal studies propylene glycol does not appear to pose a significant hazard via inhalation of the vapour. The compound appears to be safe when used as a food preservative or in cosmetics. It has also been used on children as an aerosol germicide in the United States in the 1940’s without adverse effects. However, the effects of inhaled propylene glycol on the lungs are unknown.

Unwanted outcomes could include young people using these products and becoming nicotine dependent and existing smokers using them to maintain their addiction in environments where they cannot smoke rather than quitting entirely.

New Zealand Ministry of Health (2011)


The e-cigarette provides a safer alternative for smokers. No deaths have yet been reported from e-cigarette use.

End Smoking NZ (2011)


Findings suggest that regardless of nicotine content, electronic cigarettes may provide an effective means of relieving acute tobacco craving in at least some smokers.

Darredeau, Campbell, Temporale & Barrett page 104 (2010)


I believe that the current state of knowledge about potential hazards and the risks of these causing harm are adequately addressed by the GPSR [General Product Safety Regulations] regulatory framework. The thing we are certain of on current evidence is that it is far safer than traditional tobacco based nicotine delivery systems.

UK Trading Standards, Head of Product Safety (2010)


Novel Nicotine Delivery Systems and Public Health: The Rise of the “E-Cigarette”

The ENDS tested so far have demonstrated poor quality control; toxic contaminants, albeit at low levels; misrepresentation of the nicotine delivered; and insufficient evidence of overall public health benefit. Ongoing, rigorous safety testing is needed, including determining real-world use patterns and further laboratory testing across device constructions to determine actual systemic nicotine delivery and exposure to harmful constituents.

Cobb, Byron, Abrams and Shields (2010)


E-Cigarettes: A Rapidly Growing Internet Phenomenon

Health professionals need to monitor the biological, social, and addictive effects of e-cigarettes and be aware of their rapid dissemination online. National health surveys that track trends in tobacco use also should inquire about e-cigarette use. Although the safety and efficacy of e-cigarettes is uncertain, we believe that clearly counseling patients against e-cigarette use, as well as other tobacco use, is prudent.

Yamin, Bitton and Bates (2010)


ASH … recognise that whilst efforts to help people stop smoking should remain a priority, many people either do not wish to stop smoking or find it very hard to do so. For this group, we believe that products should be made available that deliver nicotine in a safe way, without the harmful components found in tobacco. Most of the diseases associated with smoking are caused by inhaling smoke which contains thousands of toxic chemicals. By contrast, nicotine is relatively safe.
Therefore, e-cigarettes, which deliver nicotine without the harmful toxins found in tobacco smoke, are likely to be a safer alternative to smoking. In addition, e-cigarettes reduce secondhand smoke exposure since they do not produce smoke.

ASH UK briefing (2010)


Critique of the WHO TobReg report on e-cigarettes

If tobacco smoking is the elephant in the room, electronic cigarettes are like a buzzing insect. The natural instinct is of course to kill the buzzing insect first, just in case it might be harmful. This hostile analogy however, ignores the fact that smokers who like to smoke smoke either tobacco or e-cigarettes, and a move to e-cigarettes implies a move away from tobacco for the smoker concerned. If the real aim is to end cigarette smoking, banning e-cigarettes is not a sensible first move and could be counter-productive.

Laugesen (2010)


Cancer risk in humans reduced by e-cigarettes

E-cigarette use reduces risk of cancer by supplanting the smoking of tobacco cigarettes

Health New Zealand (2010)


US court judgement

“I am not convinced that the threat to the public interest in general or to third parties in particular is as great as FDA suggests. Together, both Smoking Everywhere and NJOY have already sold hundreds of thousands of electronic cigarettes, yet FDA cites no evidence that those electronic cigarettes have endangered anyone. Nor has FDA cited any evidence that electronic cigarettes are any more an immediate threat to public health and safety than traditional cigarettes, which are readily available to the public.”

– Judge Leon (2010)


Electronic nicotine delivery systems: emerging science foundation for policy

Since they were first marketed in China in 2004, electronic nicotine delivery systems (ENDS) have spread globally like wildfire. Their proponents, who refer to the products as “electronic cigarettes” or “E-cigs”, argue that by delivering nicotine to the lung, they are more effective and acceptable than nicotine replacement medicines, and should be readily available as cigarette substitutes…

– Henningfield and Zaatari (2010)


NJoy e-Cigarette Health Risk Assessment

The Njoy e-cigarette offers the consumer an interesting alternative to traditional tobacco cigarettes. While we will not advocate the use of any product, nor certify that a product is totally safe, the Njoy device appears to limit a consumer’s exposure to a few compounds of low toxicity, while delivering a metered dose of nicotine and flavor additives. Because combustion by-products, nitrosamines, and microbial toxins were not found in the aerosol of the e-cigarette, the risks associated with the use of the Njoy product appear to be low in comparison to the risks of traditional cigarettes.

Exponent Health Sciences (2009)


Marketers of electronic cigarettes should halt unproved therapy claims

… WHO knows of no evidentiary basis for the marketers’ claim that the electronic cigarette helps people quit smoking. Indeed, as far as WHO is aware, no rigorous, peer-reviewed studies have been conducted showing that the electronic cigarette is a safe and effective nicotine replacement therapy.

WHO does not discount the possibility that the electronic cigarette could be useful as a smoking cessation aid. The only way to know is to test.

The World Health Organisation (2008)

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