Time after time we have been told that there is no proof that e-cigs are better than tobacco cigarettes.
In doing so, the anti-ecig lobby, often funded by competing industries, have ignored the advice and research of the very experts and scientists who are at the forefront of electronic cigarette research.
So while last month we looked at 20 quotes from Real Experts, this week you’ll find 20 top e-cig studies that prove the doubters wrong.
You’ll also find we’ve included two studies from the ANTZ movement. These highlight the methodological issues and confusion that has dogged some studies, and show that even studies sponsored by the anti-ecig movement can demonstrate that ecigs are safer than tobacco cigarettes.
By the time you’ve finished this post, you’ll be armed and dangerous – ready to fight, and win, any e-cigarette debate.
(A big thanks to vape blogger VapeMeStoopid for putting this list together!)
1. Effects of Electronic Cigarette Use on Myocardial Function
Dr. Konstantinos Farsalinos
You’ll see Dr. Farsalinos’ work mentioned several times throughout this blog. Dr. Farsalinos is a cardiac specialist from Greece who has dedicated many hours over the last four years to studies in which e-cig vapour is studied and compared to cigarette smoke.
I have chosen this study, conducted between 2011 and 2012, as the first on my list because it set the groundwork for every subsequent electronic cigarette investigation by Farsalinos and his team. It is the first of its kind that presents clinical evidence regarding e-cigarette use and its effect on the cardiovascular function. The results showed that cardiac functions studied were not affected by the use of electronic cigarettes.
2. Hidden Formaldehyde in E-Cigarette Aerosols
I have chosen this next study because I want to show how confused researchers are about how we (vapers) use electronic cigarettes.
This study was widely circulated, and many people never questioned the methodology used. Unfortunately it was conducted under extreme conditions in which no e-cig user would knowingly or willingly continue to use their e-cig, yet was presented in the media as being “normal use”. The result was a lot of scaremongering by many top level anti-smoking organizations and public health officials.
Dr. Farsalinos responded to the study here. His response leads us to the publication of his latest study which directly addresses the NEJM study.
3. E-Cigarettes Generate High Levels of Aldehydes Only in ‘Dry Puff’ Conditions
Konstantinos E. Farsalinos, Vassilis Voudris and Konstantinos Poulas
Published on May 20th 2015, Dr. Farsalinos and his team tackled the findings of the previous formaldehyde study.
Using two customizable atomizers with different wick setups on variable wattage devices, experienced vapers then took multiple puffs at variable wattage settings with the two different atomizers. When vapers experienced “dry puff” conditions, the atomizers were connected to a smoking machine where the vapours were then trapped and tested.
Results of the tested vapour showed that high levels of aldehydes were produced only in dry puff conditions, and that under normal vaping conditions the presence of aldehydes was minimal.
4. E-Cigarette Use in the Past and Quitting Behavior in the Future: A Population-Based Study
This study, while not seemingly positive towards smokers using e-cigs to quit, says a lot about the junk science being used to create propaganda and fear in the media and among health professionals. As detailed by Dr. Siegel here, the study was not everything it claimed to be.
Nearly two-thirds of the participants were thrown out of the study; anyone who basically had even the smallest notion of what an e-cig was was removed from the study. Meanwhile this was the smallest of issues with the study itself.
The largest problem with the study was relying on the participants to assign themselves to either the e-cigarette or non-ecigarette group. This created a heavily weighted bias that intentionally showed users of e-cigs had a more difficult time quitting traditional tobacco.
It needs to be noted by anyone conducting biased research on e-cigs; there is bound to be someone in the vaping community, or a supporter of THR, who will dissect your work and call it for what it is. Junk.
5. Peering Through the Mist: Systematic Review of What the Chemistry of Contaminants in Electronic Cigarettes Tells Us About Health Risks
Published in January 2014, this study by Igor Burstyn looks at the effects of the chemicals in electronic cigarettes and whether or not we (or bystanders) should be concerned over exposures, both voluntary and involuntary. As with all chemicals of any kind, the study recommends monitoring the general health of those exposed to the chemicals in e-cigs while keeping any negative effects as small as possible.
Burstyn also highlights that exposure to bystanders is likely to be “orders of magnitude less” than direct vapour stream.
6. Safety Evaluation and Risk Assessment of Electronic Cigarettes as Tobacco Cigarette Substitutes: A Systematic Review
This review by Farsalinos and Riccardo Polosa looks at existing evidence prior to its April 2014 publication.
Based on 114 of the 451 studies they found, the two doctors doctors examined information and references pertaining to the health, use and effects of both electronic cigarette use and smoking of lit tobacco. Both determined that the vast variations of electronic cigarettes should maintain a higher level of access compared to tobacco cigarettes, and that consumers deserve to be able to make informed choices based on current and future research.
Both Farsalinos and Polosa stress that e-cigs have the opportunity:
to save millions of lives and reduce the burden of smoking-related diseases worldwide.
7. The Case in Favor of E-Cigarettes for Tobacco Harm Reduction
Joel L. Nitzkin
Published in June 2014, Joel Nitzkin looks at the role electronic cigarettes play in the formation of tobacco harm reduction policy.
Nitzkin believes that tobacco harm reduction is a viable addition to current tobacco control policies and that it’s important for smokers who are unable to quit using traditional methods. Some smokers are also unwilling to quit, but adding electronic cigarettes to the equation creates more opportunities to reduce illness, harm, and death.
8. E-Cigarettes: Methodological and Ideological Issues and Research Priorities
Professor Etter looks at the methodology and ideological issues present in current research. Methods of testing need to change as quickly as technology does when it comes to e-cigs.
Many vapers are aware that our current devices will be “outdated” in several months, and Etter stresses that long-term studies are important but it must be understood they will be outdated by the time they are published. In order to combat this, research must be done effectively and quickly.
Etter points out that failure to acknowledge that e-cigs only need to be safer than traditional cigarettes, and not completely safe, creates a negative attitude towards products that reduce the risks of smoking. The emphasis on negatives of e-cigs by public health, media and tobacco control does not always reflect the actual findings of the research conducted.
In conclusion he calls on regulators to take into account the inadvertent consequences of excessive regulation.
9. Ethical Issues Raised by a Ban on the Sale of Electronic Nicotine Devices
Wayne Hall, Coral Gartner and Cynthia Forlini –
This particular study takes a look at the ethical side of banning e-cigs. Bans prevent current vapers and smokers from choosing a less harmful product, while leaving often ineffective NRT therapies freely available.
These bans unintentionally encourage smokers to keep smoking, and prevent them having an alternative that reduces harm. By avoiding bans, but regulating less harmful nicotine products appropriately, nations would be better able to reduce harm from smoking in both adults and youth.
10. Effect of Smoking Abstinence and Reduction in Asthmatic Smokers Switching to Electronic Cigarettes: Evidence for Harm Reversal
Asthma affects a large proportion of the population and is further exacerbated by smoking or being around smokers. This study shows that by using an e-cig, asthma sufferers can reduce their cigarette use, which in turn will help reduce asthma related complications. Positive results from this study lead the researchers to recommend large controlled trials to further confirm their observations.
11. The ASSI (Anti-Smoking & Science Inventory) – Assessing the ASSS and ASSSED
Fr. Jack Kearney
Father Jack is a well-known addictions professor and certified smoking cessation counsellor who supports tobacco harm reduction and the use of electronic cigarettes. He came up with this great assessment that helps the average person identify those who are affected by a serious illness previously thought to be ANTZ (Anti-Nicotine & Tobacco Zealot).
However, through extensive data analysis, it has been identified as being an illness with various levels of severity. ANTZ has since been renamed ASSS (Anti-Smoking & Science Syndrome) and ASSEDD (Anti-Smoking & Science, Educationally Deprived Disorder). By taking a simple questionnaire you can assess whether you or a loved one suffers from this completely curable illness.
12. Exposure to Electronic Cigarettes Impairs Pulmonary Anti-Bacterial and Anti-Viral Defenses in a Mouse Model
Thomas E. Sussan, Sachin Gajghate, Rajesh K. Thimmulappa, Jinfang Ma, Jung-Hyun Kim, Kuladeep Sudini, Nicola Consolini, Stephania A. Cormier, Slawo Lomnicki, Farhana Hasan, Andrew Pekosz, Shyam Biswal
This study was widely published on clickbait websites, as well as well-known national media outlets. That caused concern among vapers and smokers, especially those that have been affected by COPD. However, when you delve into methodology and results, it becomes clear that it holds very little information relevant to smokers – or to humans, for that matter. One thing it does verify is that e-cigarettes are, indeed, less harmful to humans.
Dr. Farsalinos addressed the concerns behind the study by stating:
The only conclusions that can be drawn from this study is that e-cigarettes should only be used by smokers… any other conclusions about the probable effects of e-cigarette use on COPD patients are totally irrelevant.
13. Comparison of the Effects of E-Cigarette Vapor and Cigarette Smoke on Indoor Air Quality
McAuley TR1, Hopke PK, Zhao J, Babaian S.
In 2012 one of the first studies looking at indoor air quality differences between smoke and vapour was published. This study is important because it highlights that even three years ago, we were able to determine the extremely low exposure levels of the vapour left behind, which indicated no risk to human health, while exposure to tobacco smoke caused a significant risk.
More studies like this need to be conducted to reaffirm that vapers are not causing harm to those around them.
14. The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes
Vapers know that flavours play a big part in our vaping journey. We also know that we are constantly under the scrutiny of those who imply manufacturers are marketing to children with candy or sweet flavors. This study shows that non-smoking teens were less attracted to flavours than adult smokers. Interest among both groups was relatively low, but in the adult smoker group, interest was greatly affected by the presence of e-liquid flavours.
15. Effectiveness of the Electronic Cigarette: An Eight-Week Flemish Study with Six-Month Follow-up on Smoking Reduction, Craving and Experienced Benefits and Complaints
Karolien Adriaens, Dinska Van Gucht, Paul Declerck and Frank Baeyens
This study tested a range of determining factors in the process of cessation over a period of 8 weeks, using two groups of e-cig users and a control group. It showed that second generation e-cigs (not cigalikes) were very effective reducing cigarette cravings and withdrawal symptoms, with nearly half of the participants completely abstaining from traditional tobacco for at least 6 months after the lab sessions.
As with all smaller studies, the researchers encourage large scale trials to confirm their results.
16. Stigma and the Ethics of Public Health: Not Can We but Should We?
17. Smoking, Stigma and Tobacco ‘Denormalization’: Further Reflections on the Use of Stigma as a Public Health Tool. A commentary on Social Science & Medicine’s Stigma, Prejudice, Discrimination and Health Special Issue
Bell K, Salmon A, Bowers M, Bell J, McCullough L.
While these studies, published in PubMed back in 2008 and 2010, are not about vaping, all us vapers were smokers at some point in our lives. In the world of vaping advocacy it is important to remember not to stigmatize smokers for their choice to smoke or lack of willingness to quit.
By demonizing smokers (or vapers) we run the risk of discouraging people from making well-informed choices about their health and those around them. Public health officials should also remain unbiased and refrain from judgmental behaviour. Remaining positive and encouraging, while providing good information, will help smokers make the switch to vaping.
New for 2015
18. Smoking in England, the Smoking Toolkit Study
The Smoking Toolkit Study is an important source of information that every vaper should follow. They have been collecting data since 2006, so far totalling over 180,000 responses from smokers and ex-smokers. Their most recent publication in May 2015 shows a clear decline in smoking but also a drop in the use of NRT products.
The use of electronic cigarettes spiked in February 2015 to surpass over the counter and prescription NRT, as well as stop smoking services provided by the NHS. This data is promising for smokers that are looking to reduce harm, and shows that e-cigs are a viable and popular option. It also goes a long way to counter arguments that e-cigarettes don’t help smokers stop using tobacco cigarettes.
19. Use of Electronic Cigarettes (Vapourisers) Among Adults in Great Britain
Action on Smoking and Health
May 2015 brought even more promising data from ASH. Up from 2.1 million e-cig users in 2014, the May data shows that an additional half a million smokers made the switch to e-cigs. The fact sheet shows that most smokers are using e-cigs to reduce the amount they smoke or help them stop completely. The data shows that the 2.6 million UK adults using e-cigs are current or former smokers.
However, it is concerning that between 2014 and 2015 the percentage of current smokers using an electronic cigarette remained at 17.6%. Does this also show that unnecessary fear mongering and negative campaigns against e-cigs are causing smokers to be more hesitant about making the switch?
20. Nicotine Levels and Presence of Selected Tobacco-Derived Toxins in Tobacco Flavoured Electronic Cigarette Refill Liquids
Dr Farsalinos and his team tested 21 samples of e-liquid and compared them against chemicals found in tobacco products. While his study confirms that e-liquids are not free from potentially harmful chemicals similar to those found in tobacco products, and that e-liquids containing naturally extracted tobacco could result in higher exposures, e-liquids still contained much lower levels of TSNAs and nitrates, making them less harmful than tobacco products.
This study is very promising in determining the level of risk vapers are faced with compared to smoking, but further studies would need to be conducted to continually verify what we all have known for years now – electronic cigarettes are much less harmful than smoking.
21 New: Electronic cigarette use and harm reversal: emerging evidence in the lung
We had to update this article with the latest study from Polosa, who found that switching to e-cigs from cigarette could lead to improvements in lung problems caused by smoking. 65.4% of people with asthma and 75.7% of people with COPD reported an improvement in symptoms, with over 18% no longer needing any medicine.
Polosa went on to write:
…the emerging evidence that EC use can reverse harm from tobacco smoking should be taken into consideration by regulatory authorities seeking to adopt proportional measures for the e-vapor category.
One of the most frustrating claims we have heard (repeatedly!) over the years is:
“We just don’t know if ecigs are safe.”
Yet the studies here are just a small fraction of the total studies carried out into e-cigarettes. And while e-cigarette may not be ‘safe’, the studies do show that they are far ‘safer’ than tobacco cigarettes. In fact, the consensus amongst e-cig researchers is that they are around 95% safer than tobacco cigarettes.
So next time you hear a wild accusation about electronic cigarettes, try pointing them towards a study that counters that claim!
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