An Interview with Prof. Carl Phillips on E-Cigarette Safety

About Prof. Carl Phillips

Prof. Carl V. Phillips received his PhD in public policy from Harvard University and completed fellowships in health policy at the University of Michigan and philosophy of science at the University of Minnesota, has additional degrees in math and history, and was on the faculty of the University of Texas Medical School’s Center for Evidence-Based Medicine.

He is currently an epidemiology and economics consultant and researcher, CASAA Sci Director and ex prof of public health. Much of his research focuses on tobacco harm reduction and his university research group produces the education and research website, TobaccoHarmReduction.org.

Prof. Phillips expects to create a private research institute so that he can devote more time to researching and promoting tobacco harm reduction without political interference by anti-nicotine extremists.

Carl Phillips

ECD: Given what we know about the ingredients and carcinogens contained within the electronic cigarette, is there reason to believe it could be a safer alternative to regular cigarettes?

Carl Phillips: I think that’s quite an understatement. I think there’s absolutely no doubt that it is a safer alternative to regular cigarettes. Now safe, that’s a word that implies there is absolutely no health risk from something, and that doesn’t really apply to anything. But our estimate is that it is probably in the order of 99 percent less harmful than smoking, I think there’s little doubt that it’s down in the neighbourhood.

ECD: Professor Michael Siegel suggested that if we banned electronic cigarettes based on the carcinogens found in the FDA study we would have to ban peanut butter. Is that something you would agree with?

Carl Phillips: At least! We’d have to ban half the foods that are available. I mean, the FDA study really didn’t find any cancer risk. That study was basically pure propaganda.

“I think there’s absolutely no doubt that it [the e-cigarette] is a safer alternative to regular cigarettes.”

ECD: Is there any danger of passive smoking with electronic cigarettes?

Carl Phillips: Probably not. As far as we know, the vapour, the propylene glycol vapour, has no human health risks at low concentrations, so it’s possible that there’s some minuscule risk, far too small for us to have ever noticed it or measured it. The amount of nicotine that escapes out into the air is also quite trivial and nicotine itself has such a low risk profile… so again it is never proper science to say that there is absolutely no risk from something, just as it is not proper science to say simply that there is a risk from something without trying to quantify it. But I guess there is no serious risk from second hand vapour as I guess it would have to be called.

ECD: In your opinion, could the electronic cigarette aid smoking cessation or be of use as a tobacco harm reduction product?

Carl Phillips: Yes, not only could it but it clearly is already being used for exactly that. Self-reports suggest that thousands, tens of thousands of smokers have quit smoking by switching to the electronic cigarette which is the perfect proof that it does work as a smoking cessation aid and a tobacco harm reduction tool.

“Self reports suggest that thousands, tens of thousands of smokers have quit smoking by switching to the electronic cigarette.”

ECD: Electronic Cigarettes have been in use for several years now, and there are a few organisations which are concerned about them. What side effects have been found so far?

Carl Phillips: As far as I know there hasn’t been any discoveries of acute side effects, which of course is good news. There is no reason to expect any but you never know quite what is going to happen with a new exposure. You can have reports that start to trickle in of a case here or there of something very strange happening. I’m not aware of any such thing.

We of course know that long term use of nicotine poses a small, a very small but non-zero risk of some cardiovascular diseases so I suppose you could call that a side effect which is predictable for the long run, but that’s a total risk which is down in the range of drinking coffee, nothing remotely similar to the risk from smoking cigarettes.

ECD: What’s your biggest concern with regards to the electronic cigarette?

Carl Phillips: Well, we don’t know too much about the manufacturing process and there’s not enough quality control, or at least there is not enough guarantee of quality control in the process.

Now, this of course varies from manufacturer to manufacturer, but with reasonably free entry that just about anybody with an appropriate factory in China can start manufacturing these and start putting them out under some brand name there is worry about contamination. I mean this is not a plastic toy or something like that, which alone generates a lot of worry about Chinese manufacturers.

This is something that is delivering chemicals into the body in a way which is definitely going to be absorbed so it doesn’t take much of a production mishap to create something that is very harmful. And I really fear that it is going to happen one of these days if we don’t get some effective regulation and it is going to give the entire product line a bad name which of course would be inappropriate but quite understandable.

ECD: Following on from those concerns about the quality of production, let’s talk about the FDA. The FDA carried out tests on electronic cigarettes in which they found diethylene glycol in one “Smoking Everywhere” e-cigarette and traces of tobacco specific nitrosamines in both Smoking Everywhere and NJOY electronic cigarettes. So what are the significance of those findings?

Carl Phillips: There’s no significance of those findings whatsoever from a scientific or health standpoint. From a political standpoint the fact that they did that was quite significant.

“There’s no significance of [the FDA] findings whatsoever from a scientific or health standpoint.”

So on the first point the fact that there are any detectable levels of any small molecules that that can be found in the tobacco plant in the e-cigarettes is not surprising at all. The nicotine comes from tobacco and our ability to detect a few stray molecules of contamination means that basically any molecule that is small enough to be a contaminant that is found in the tobacco plant will also be found in e-cigarettes. It’ll also be found in Nicoderm, Nicorette, any product that contains nicotine that has been extracted from a tobacco plant. So that’s completely meaningless – the quantities of the nitrosamines in the electronic cigarette were so many orders of magnitude smaller than those, say, in smokeless tobacco, which has been shown to not cause a measurable risk of cancer, so we know that that doesn’t matter.

Now, there is some more significance in finding contamination in the carrier chemicals, not that there was enough in this particular case that it was going to be harmful but because there is not supposed to be anything other than the propylene glycol and the water there, it does mean that there is a manufacturing problem – a manufacturing problem under some circumstances could be quite a bad thing. Now what really is the biggest problem is the politics that this reflects. This shows up in all sorts of harm reduction type situations and the basic rule of thumb is, if you ban something or if you’re trying to ban something, declare war on it, then you can’t regulate it, you can’t make it safer. So if you have a war on injection drug use and you simply want to forbid it and don’t want to admit it is happening in any way, you will prevent needle exchanges from happening which would save a lot of lives.

If you want to have a war on prostitution and just absolutely forbid it and pretend it doesn’t exist then it is impossible to impose rules that force prostitutes to get health exams and so forth.

Similarly if the FDA is intent on declaring war on electronic cigarettes and simply forcing them from the market then they are going to be abdicating their responsibility to make sure that the electronic cigarettes are what they are supposed to be and keep them safe and that goes back to this quality control problem. The FDA would really be the perfect entity to help impose some quality control on ecig manufacture even though they are manufactured in a different country but it looks pretty bad in terms of the possibility of them doing that.

ECD: What health benefits, if any, might smokers find if they smoked electronic cigarettes, or changed to electronic cigarettes?

Carl Phillips: The health benefits of switching are almost exactly the same as the health benefits of quitting, and this applies to electronic cigarettes, smokeless tobacco and pharmaceutical nicotine. If a smoker can manage to switch from smoking to one of those other

“The health benefits of switching are almost exactly the same as the health benefits of quitting…”

products the benefits are approximately the same as quitting – they lower their cancer risk, they lower their cardiovascular disease risk, they get rid of acute symptoms of lung and airway problems, a risk that comes from smoking for pulmonary diseases and so forth. Switching is so close as good as quitting that from a health point of view there is no point in worrying about the difference.

Please note that comments of the interviewee do not necessarily represent the views of ECigaretteDirect.
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