An Interview with ECigarette Expert Dr Joel Nitzking (Part 2)

ECD:Regulation aside, would it be possible to measure the effects of the electronic cigarette on smokers who have already switched to the electronic cigarette?

Dr Nitzkin: That would be very difficult. The question is compared to what? If most of the people who are smoking electronic cigarettes have been smoking regular cigarettes before, who knows how much of the effects of the regular cigarettes would already be there. Now, our idea, us being the American Association of Public Health Physicians, would be that products such as e-cigarettes and the sticks and the strips and the orbs should be allowed on the marketplace based on the research that has already been done. Once on the market place there would have to be strict quality control of the manufacturing process which would allow the FDA to inspect the plants and require the testing that we talked about done by an outside laboratory.

In addition to that , there would have to be post market research or post market surveillance which I think would have to be done by the federal regulatory agency using the user fee revenues. This would entail them doing studies, they would enrol regular smokers and e-cigarette smokers and then, over a period of years, while it is on the market and being sold, assess the presence or absence of any kind of adverse effects. You know, I just saw a news reports that crossed my desk today that said the nicorette gum may pose a cancer hazard that previously wasn't suspected. I haven't read the report yet but those are the kind of things that we need to watch out for.

"I don't think there is any question, there is no possibility that e-cigarettes could be anywhere near as harmful as cigarettes."

One way or the other I don't think there is any question, there is no possibility that e-cigarettes could be anywhere near as harmful as cigarettes. Cigarettes kill thirty percent of the people who use them. And with e-cigarettes we are talking small fractions of one percent.


ECD: There's a body in the UK, ASH UK, that says that at least until there has been more research smokers should stick to products such as nicotine patches and gum. How do you rate the effectiveness of these products?

Dr Nitzkin: Well, there are two problems with the nicotine patches and gum.

"...the way they [nicotine patches and gum] are formulated means that they don't give the nicotine hit that a smoker desires."

Problem number one, the way they are formulated means that they don't give the nicotine hit that a smoker desires. It's a long slow release packaging of the nicotine so it doesn't offer the same satisfaction. Problem number two is that these products have only been licenced for use for short periods of time, basically up to twelve weeks as smoking cessation products. Now if somebody is going to suggest that a smoker is going to use one of these products for longer than twelve weeks, then that is what is called an off-label or illegal use of the drug, because it has not been approved for use for longer than twelve weeks.


ECD: Although that would still be better than smoking.

Dr Nitzkin: Oh, it would definitely be better than smoking.


ECD: They're basically running into the same problems as electronic cigarettes, then.

Dr Nitzkin: Yes, the research has never been done in terms of long term effects..


ECD: Now another concern, especially of non-smokers who have been raising this in comments on blogs and articles, is that the electronic cigarette still contains nicotine. Whereas my understanding is that nicotine is not that bad when compared to the use of tobacco. What is your opinion on this?

"Tobacco is more than 100,000 times riskier in terms of risk of death from routine use of a product than is normally considered acceptable..."

Dr Nitzkin: Well, nicotine is not innocuous and nicotine is very strongly addictive. Compared to foods and food additives that are acceptable on the market place nicotine would be considered a risky substance because people with underlying heart disease could suffer damage from the nicotine but compared to ciagrettes ... let me try to put this in a kind of simplified perspective this is something that again - I don't know if you have downloaded our harm reduction resolution white paper, but basically at the end of the white paper it talks in terms of order of magnitude differences between tobacco and other products. Tobacco is more than 100,000 times riskier in terms of risk of death from routine use of the product than is normally considered acceptable from a consumer point of view. So if you have a product which is three orders of magnitude less risky than a cigarette, that is less than one tenth of one percent the hazard of a cigarette, that's still 100 more times more hazardous than is generally accepted for consumer products. So, you know, you have these vast differences.

So the question is compared to what? We don't want to encourage non-smokers to take up e-ciagrettes or these alternate devices but we do want to encourage smokers to switch.


ECD: Yes, I spoke to David Sweanor and he said much the same thing.

There is one criticism I have seen which is that we don't know the effect of heating up and inhaling nicotine and that this could potentially cause harm.

Dr Nitzkin: That's true, we don't know the effects of that and we can only guess at what the impact can be. My guess is that it would probably make it somewhat more toxic to people with heart disease, that's research that ought to be done. The other factor that I don't know with e-cigarettes is how much of the nicotine actually gets down to the lung. Is it absorbed from feural mucosal like cigars are, or is it absorbed from the lung by patterns of inhalation like smokers use. It's probably in the lung like smokers do because people I think because people tend to use them in the same way. But that is research that needs to be done, there is an open question there, but compared to what we already know the likely risk would appear to be much smaller than cigarettes...


ECD: But it would be difficult to carry out the research?

Dr Nitzkin: That research would not be terribly difficult to carry out. That research would require one of the companies to hire a skilled researcher to probably get somewhere between 40 and a hundred non-smokers or actually maybe even smokers could do this. Have them randomized, have half of them using e-cigarettes with no nicotine, the others using e-cigarettes with nicotine, and then you could measure cardiac status, and you could measure other blood tests to see what is going on. That would not be a difficult study to do.

"The increased risk of cancer study would require decades to complete. And probably it couldn't be done."

Let me clarify, let me add one thing to that statement. That would be an easy subject to do it you are looking at acute short term health effects. That would not give you any ideas as to whether or not there is a long term effect like an increased risk of cancer. The increased risk of cancer study would require decades to complete. And probably it couldn't be done.


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