How to explain the science behind electronic cigarettes to MPs and MEPs

3D representation of Albert Einstein with ruler in hand.

Following yesterday’s post, several e-cigarette users have shared replies from MPs and MEPs regarding the EU directive that seeks to effectively ban electronic cigarettes. While some of have promised to oppose the directive, others have asked for more information. In this post, I’m hoping to provide a summary of the science behind vaping without using too many words (assuming politicians are incredibly busy people!)

Of course, it is better to write this in your own words, but if you are busy, stuck or just need a starting point this might help you! Please feel free to leave comments or suggestions on how this post could be improved, and also feel free to use this post for your own use.

The Science

Scientists estimate that 99% of the harm caused by smoking stems from combustion and tar.

Nicotine, which is both addictive and a stimulant, is not 100% safe, but the risk is similar to caffeine, and is vastly safer when taken in a noncombustible form. (Source: ASH UK “…the harm from smoking is caused almost exclusively by toxins present in tobacco released through combustion” https://www.ash.org.uk/files/documents/ASH_715.pdf)

In contrast to electronic cigarettes, nicotine is vapourised by heating up a liquid base. Crucially, at no point does combustion take place. The UK Government Nudge Unit believes devices like ecigarettes have the ability to save thousands of lives (source: https://www.guardian.co.uk/society/2011/sep/14/smokeless-nicotine-cigarettes-government.)

The principle ingredient in electronic cigarette cartridges and ‘eliquid’ is propylene glycol. Propylene glycol is regarded as very safe (source: Safety Report by Health New Zealand https://www.healthnz.co.nz/RuyanCartridgeReport30-Oct-08.pdf), and has been used in air-conditioners, medicines, drinking water and to sterilise children’s hospital wards. Some people are, however, allergic to propylene glycol – an alternative for these people is to use a vegetable based glycerine.

Studies

There are numerous studies on electronic cigarettes – a selection include:

Farsolinos 2012: Electronic Cigarette and Cardiac Function
(Source: Electronic Cigarette Do Not Damage The Heart
https://www.escardio.org/about/press/press-releases/esc12-munich/Pages/acute-effects-electronic-cigarettes-heart-damage.aspx?hit=dontmiss)

Flouris Et Al 2012: Acute effects of electronic and tobacco cigarette smoking on complete blood count
(Source: https://www.sciencedirect.com/science/article/pii/S0278691512005030
Found that vaping, in contrast to smoking, has no effect on the number of white blood cell, lymphocyte, and granulocyte counts in blood.)

Polosa et al (Italian Non Smoking Association): The effect of electronic cigarettes in helping cigarettes smokers to reduce or eliminate tobacco
Found that e-cigarettes helped over 50% of smokers to reduce or eliminate tobacco cigarettes. The doctor discussed the results here: https://www.ecigarettedirect.co.uk/ashtray-blog/2011/10/electronic-cigarette-interview-professor-riccardo-polosa.html

Cahn and Siegel; 2011 Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes?(Source: https://www.palgrave-journals.com/jphp/journal/v32/n1/abs/jphp201041a.html Found that electronic cigarettes are “undoubtedly” safer than tobacco cigarettes.)

Quotes from Scientists and Campaigners:

Dr Joel Nitzkin, Chair of the Tobacco Control Task Force for the American Association of Public Health Physicians: “…we have every reason to believe that the hazard posed by e-cigarettes would be much lower than one percent of the hazard posed by cigarettes.”

Professor Michael Siegel, associated Professor at the Boston University of Public Health: “Inhaling nicotine cannot be nearly as dangerous as inhaling nicotine plus thousands of other chemicals, including more than 40 carcinogens.”

Professor Carl Phillips, former Professor at the University of Alberta, and researcher in the field of tobacco harm reduction: “I think there’s absolutely no doubt that it [the e-cigarette] is a safer alternative to regular cigarettes.”

David Sweanor, Former advisor to the WHO on tobacco control: “If there is anyone who believes cigarettes are no more hazardous than e-cigarettes I’d recommend a remedial course in basic sciences.”

Dr Murray Laugesen, Former principal medical officer in the New Zealand department of health and winner of a WHO medal for work in the field of tobacco control: E-Cigarettes are “harmless: inhaled or exhaled.”

Further information:

Action on Smoking and Health: Action on Smoking and Health Briefing on Electronic Cigarettes: https://www.ash.org.uk/files/documents/ASH_715.pdf

Europe making bad policy on nicotine – five ways to make it better: https://www.clivebates.com/?p=697 (By Clive Bates, former direction of ASH UK)

Electronic Cigarettes on the Consumer Advocates for Smoke Free Alternatives Assocation https://casaa.org/Electronic_Cigarettes.html

Sample Email

Paul is one of several people who has shared his email correspondence – I thought this response to the MEP was excellent and am sharing it with his permission (Paul’s last name and email address removed for privacy):

Re: Draft EU Directive to ban/prohibit smokeless smoking substitutes.

I had been a cigarette smoker for nearly 40 years. I have tried for many years to quit smoking without success. While holidaying in the USA I came across electronic cigarette (E-Cigs). I was curious as they claimed to have no combustion of tobacco and therefore no tar no carbon monoxide and also claimed almost zero carcinogens.

At first I was very skeptical about these products, however, being an ex pharmacist, I decided I would investigate further. What I discovered was very interesting. I read a great deal about both the pro’s and con’s of electronic cigarettes.

It soon became obvious to me that there is a lot of vested interests from the tobacco companies and pharmaceutical companies that electronic cigarettes do not reach the market.

I have also read documents from respected professional bodies which are convinced that electronic cigarettes are far safer than conventional cigarettes. The American Association of Public Health Physicians, for example, urge the FDA to reconsider Its stance on E-Cigs. It claims that between 5 and 8 million lives could be saved in the US over the next 20 years by people changing to E-Cig. The UK organization ASH are also in favor of them being freely available.

I have been smoking electronic cigarettes now for nearly a year. My health has improved immensely. If this proposed EU directive is ratified I for one will probably return to smoking conventional cigarettes and therefore endanger my health.

I cannot believe that the UE should try and ban the free availability of E-Cigs. This would truly be a backward step. It is unethical and immoral to condemn people to continue smoking convention cigarettes when a far safer alternative is available.

I urge you to do whatever you can to prevent this and to make contact with ENVI.

Yours sincerely,

Paul

From: Catherine Bearder MEP [mailto:[email protected]]
Sent: Tuesday, January 29, 2013 10:39 AM
To: xxxxxxxxxxxx
Subject: Electronic cigarettes

Dear Mr  xxxxxxxxxxxx   ,

Thank you for contacting me regarding the revision of the Tobacco Products Directive.

Whist the overall objective of the revision is to improve the functioning of the internal market, it is expected that citizens in all Member States will benefit from improved public health.

I understand that as a previous heavy smoker you are concerned by the idea that electronic cigarettes could be banned by this Directive. However, electronic cigarettes containing nicotine over a certain threshold will be allowed if they have been authorised as pharmaceuticals. It is only cigarettes, roll-your-own and smokeless tobacco products that have a characterising flavour, such as menthol cigarettes and smokeless tobacco with a liquorice taste that will be prohibited.

As electronic cigarettes are still a relatively new invention, I believe that much more research needs to be done before a final Directive can be agreed on. Evidence on the safety of e-cigarettes is limited and there is no evidence regarding the health effects of long term use.

My main concern is the health effects of electronic cigarettes. Although preliminary tests of the original e-cigarettes produced by Ruyan, a Chinese electronics company, suggest that they are relatively harmless in comparison with smoking, there are now many different models on the market that have not been tested. Further, a draft review by the WHO’s Tobacco Regulatory Group notes that the extent of nicotine uptake and the safety of e-cigarettes have yet to be established. In addition, a study on the acute pulmonary effects of using an e-cigarette found that there are immediate adverse physiological effects after short term use that are similar to some of the effects seen with tobacco smoking. Further, the World Health Organisation (WHO) reported that there is concern that nicotine delivery to the lung might result in stronger toxicological, physiological and addictive effects.

I do however believe that this evidence must be balanced against the numerous studies where smokers, including yourself, have been able to quit conventional cigarettes after taking up an e-cigarette.

One of my Liberal Democrat colleagues in the European Parliament, Marielle de Sarnez, has recently written a question to the European Commission about the use of electronic cigarettes. A copy of her question is copied here for your reference. I will of course keep you updated when an answer to this question is provided by the Commission.

Over the last few years, more and more people in Europe have started using electronic cigarettes. According to a study by the Commission’s Directorate-General for Health and Consumers, 7 % of EU citizens claim to have tried them and the total value of the EU market was between EUR 400 and 500 million in 2011. These new e‐cigarettes, which can be recharged using cartridges containing nicotine and flavourings, use a mechanism that produces water vapour, rather than burning tobacco which produces tar. Manufacturers claim that they are less harmful than standard cigarettes. However, it is still not completely clear how smoking electronic cigarettes affects people’s health. The World Health Organisation does not think that they should be used to wean people off standard cigarettes and still classifies nicotine as a ‘very dangerous’ substance. According to a 2010 study by the French National Research and Safety Institute, the liquid used to recharge the cigarettes also contains traces of propylene glycol, which can be toxic if consumed in large amounts. The French Agency for the Safety of Health Products (AFSSAPS) does not recommend that people use e‐cigarettes to give up smoking, because it is still not clear how they affect human health. The agency’s fear is that people who are not addicted to cigarettes and nicotine would develop an acute addiction by using these products. In 2010, the Commission, in its answer to a parliamentary question, said that it would look into the issue of electronic cigarettes and assess ‘the impact of a (…) revision of the Tobacco Products Directive’

Given that it is not clear how electronic cigarettes affect consumer health and whether they can lead to addiction, does the Commission intend to carry out a study into the potential risks of e‐cigarette use, particularly among young people? Does it plan to revise EU legislation on smoking to take account of its findings?

I will continue to monitor the situation closely and look forward to the European Commission’s response on e-cigarettes in order to make an informed decision regarding their use before the first vote takes place on 25th February 2013.

Yours sincerely,

Catherine Bearder MEP

Liberal Democrat member of the European Parliament for the South East of England

Constituency Office

27 Park End Street

Oxford

OX1 1HU

www.bearder.eu
Dear Ms Bearder,

Thank you for your email reply.

I read it and the comments of your colleague with interest. I found, what I read, quite disturbing!

The most disturbing is the statement of your colleague Marielle de Sarnez. She say that E-cigs have been found to contain traces of propylene glycol. I think she confusing propylene glycol with ethylene glycol. Up to 90% of the “E-Liquid IS propylene glycol. This is a very well known molecule and is used widely in the food and pharmaceutical industry and is an approved “foodstuff” worldwide. We all consume propylene glycol every day in processed food and many soft drinks. Propylene glycol is used in medicines including inhalers! There was a case (in South America) where an unscrupulous company did use ethylene glycol but your colleague should not give the impression that this chemical is used widely. It is this type of scaremongering, caused through ignorance or misinformation, which unfairly damages the safety record of E-Cigs.

I have heard that this EU directive may try and reduce the amount of nicotine in E-Cigs to a maximum of 8mg/ml. This would be disastrous. At this level the “nicotine addict” (like myself) would not get any satisfaction from “smoking” E-Cigs. They will try them and promptly return to smoking conventional cigarettes and subsequently suffer the smoking related illnesses. For the first time E-Cig smoker about 18mg to 24mg/ml (1.8 to 2.4%) is what appears to be the optimum for people changing to E-Cigs. This compares very well with nicotine replacement products like nicotine chewing gum and nicotine inhalers (in fact taken in their recommended maximum daily doses these legitimate nicotine replacement product contain far more nicotine than E-Cigs).

Most E-Cig user are fully informed about the products they are using. There is a lot of information on the internet including forums. I believe that E-Cig users should have the right to make their own decisions. If sales of E-Cigs are banned or suspended (while some form of legislation is forthcoming) this would be disastrous.

In 2010 MHRA (Medicine and Healthcare Product Regulatory Agency) held a public consultation (MLX 364). Baring in mind that E-Cigs were only available online, and it was very early days, many hundreds of E-Cig users responded that their health had improve by E-Cigs and most feared that if E-Cigs are strictly regulated or banned then they would return to smoking conventional cigarettes. I urge you to read some of the of the responses from the general public. It demonstrates how REAL people feel and that they are very fearful of regulation. This is the link:

https://www.mhra.gov.uk/Publications/Consultations/Medicinesconsultations/MLXs/CON065617

I do agree that further studies should be carried out and the nicotine liquid (E-Liquid) should be standardised  but most health professionals (non biased either way) who have taken an interest in E-Cigs agree that they are far far safer than conventional cigarettes. There are a lot of studies and expert opinion if you take the trouble look.  I, like many people, have found it impossible to quit and or do not wish to quit. It is a case of harm reduction. I fear that legislation will impact on the choice we have.

I agree that children and non smokers should not be attracted to these products. I think they should be treated like conventional cigarettes. That is to say, not sold to minors, health warnings regarding their addictiveness and not sold in the array of flavours currently available (which could be attractive to children) etc.

I summing up I would just like to say that I sincerely hope that common sense prevails and that the people who represent us (who are addicted to lethal conventional cigarettes) in the EU listen to us and not other bodies/companies that obviously have another agenda.

Best regards,

Paul

 

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