Dirty Secrets Report - Exposed

‘The Dirty Secrets of Those “Healthy” E-Cigarettes’ – Debunked

Exposing Discovery Health’s Misinformation on E-Cigarettes

A customer recently sent us a report entitled: The Dirty Secrets of Those “Healthy” E-Cigarettes.

Lee Johnson investigates. 

Vapers have gotten wearily accustomed to seeing extreme, unsupported statements made about vaping.

It seems like a week can’t go by without somebody going above and beyond the evidence to scare people away from the safer alternative.

The latest example comes in the form of a Discovery Health Report which proudly claims to “expose mainstream cover-ups.”

In the area of e-cigarettes, where the evidence indicates that vaping is substantially safer than smoking but most of the public don’t realise it, something is in dire need of exposing.

Why, contrary to all available evidence, do people believe that e-cigs are as dangerous as combusted tobacco? How did we end up in this situation?

Sadly, these aren’t the questions the report’s author Jason Kennedy decides to answer. Instead, he asks:

“Are they truly safer? And do they really cut your risk? The truth is more complex than makers would have you believe.”

The rest of the report is a whistle-stop tour of some long-debunked arguments, over-interpretation of flawed studies and the toxic blend of fear, uncertainty and doubt that has plagued the technology since it was first introduced.

But is it really all that bad? Well, yes. It really really is.

Here is what Jason Kennedy wants you to think, and what the evidence really says:

1 – The Genetic Impact of Vaping

What the Report Claims

The report opens by citing a study that looked at the impact of vapour on the immune system genes in the cells that line your airways. It states:

Cigarette smoke can influence up to 53 defensive genes in the lining of your lungs. Doctors at the University of North Carolina (UNC) found e-cigarettes may be worse. They can influence 358 defensive genes – about 7 times more than tobacco.

What the Evidence Really Says

Riccardo Polosa published a critique of the paper, and has this to say about its findings:

Given that history of tobacco smoking exposure is important in dictating stable epigenetic changes, the reported suppression of a large number of genes in vapers is obviously related to their previous smoking history and not to their current vaping. Besides, you cannot infer any clinical implications from such epigenetic changes.

The bottom line is that the researchers didn’t control for the amount the participants had smoked.

Somebody who smoked two packs a day for 10 years before starting vaping could be compared with someone who’s smoked half a pack a day for just a year. The gene changes seen in the vapers are more likely to result from their smoking history rather than the fact that they vaped.

The authors would have been able to conclusively demonstrate that vaping was to blame if they followed the participants as they switched from smoking to vaping rather than just looking at them at a single point in time.

Finally, all of this ignores a big issue: we don’t really know whether these gene changes will have a real-world impact on vapers anyway. As the authors of the study state:

Our data do not demonstrate whether and how the decreased expression of genes associated with cytokine/chemokine signaling is of biological significance.

In other words: “we don’t know if these results will have any real-world relevance.”

They do go on to suggest it will probably impact the respiratory immune system, but this is really just an untested hypothesis.

2 – The Ingredients are Approved for Ingestion, Not Inhalation

What the Report Claims

The report states “the FDA has approved more than 7,000 e-cigarette flavors. But the approvals are based on oral ingestion – not inhalation.”

What the Evidence Really Says

It is true that the approvals of food flavourings are based on ingestion rather than inhalation, and diacetyl is an example of a chemical that’s safe to eat but not safe to inhale. However, the fact that the chemicals aren’t approved for inhalation tells you nothing about the risks of inhaling them.

Like diacetyl, there could be some that prove harmful, but with no evidence of risk, this is pure speculation.

And it conveniently ignores the multiple flavouring chemicals (including diacetyl) which you’ll find in cigarette tobacco and the smoke from cigarettes.

(While the levels of diacetly in e-liquid may or may not be harmful, our own e-liquids are tested for ingredients like diacetyl. See here for details or testing certificates.)

3 – Formaldehyde, Formaldehyde and More Formaldehyde

What the Report Claims

“French researchers found e-cigs expose users to proven cancer-promoting compounds like formaldehyde. They also discovered the devices grow more dangerous with use.”

What the Evidence Really Says

As most vapers know, thanks to the infamous New England Journal of Medicine formaldehyde study, e-cigarettes can produce formaldehyde in substantial quantities. However, this only occurs if you vape at too high a setting for your atomizer.

This tastes really awful, so nobody vapes at these settings without a suitable atomizer. We covered this in a bit more detail here.

At usable settings, e-cigarettes do release small quantities of formaldehyde, but much less than you’d get from a cigarette and at levels not expected to pose a risk to vapers’ health.

The referenced study does show that older coils are worse, but like the more famous formaldehyde study, doesn’t represent how vapers use e-cigs in the real world.

Riccardo Polosa also stresses the difference between real-world use and how the e-cigs were used in these studies:

Production of high levels of toxins does not happen under normal condition of use. It occurs only when applying non validated laboratory protocols that lead to excessive production of by-products generated by thermal degradation of e-liquid ingredients. This is so true that level of toxicants in the urine and exhaled breath of vapers are orders of magnitude lower than when smoking.

4 – E-Cigarettes Irritate Your Lungs

What the Report Claims

“In another recent study, doctors discovered fruit and other non-tobacco flavors of e-cigs are more dangerous than the tobacco flavors. But all flavors increase airway irritation and inflammation.”

What the Evidence Really Says

The first part of the statement doesn’t appear related to any of the references they provide, but may be referring to diacetyl, which we discussed in point 2. The upshot is that cigarettes contain 100 to 200 times more diacetyl than e-cigarettes, and we have no evidence that the amount present in e-cigarettes will pose a risk to users. We’d recommend avoiding diacetyl-containing liquids, though (more on that here).

The second part seems to refer to this study, which did find inflammation and irritation in lung cells exposed to e-cigarette vapour. It could well be that this irritation leads to problems over the long-term, but it also could be that it doesn’t.

As Dr. Michael Siegel frequently points out, short-term irritation could be a transient issue which never turns into a full-fledged health problem. Just because something alters a measurement taken in a lab doesn’t mean that it will cause problems in the real world.

5 – “Dangerous Particles”

What the Report Claims

“Researchers also found vaping exposes users to levels of dangerous particles similar to cigarette smoke or diesel emissions.”

What the Evidence Really Says

The issue of “particles” in e-cigarette vapour, especially the comparison with smoke or diesel emissions, is incredibly misleading (as discussed in detail by Clive Bates and Carl V. Phillips). Firstly, e-cigarette aerosol is a mist of liquid droplets. You can call these particles if you like, but it isn’t particularly informative.

The other part of the claim is that the particles are “dangerous,” but no further evidence is given for this. The issue really depends on what the “particles” are composed of. When you shower, you’re exposed to many particles (i.e. droplets) of water, but since it’s just water, it wouldn’t make much sense to get all worried about inhaling particulate matter when you shower (unless you’re showering in polluted water – which we don’t recommend, by the way).

So the chemistry of e-cigarette vapour is what the authors really should focus on. We’ll cover this later, but the short version is that any harmful chemicals detected in e-cigarette vapour to date are in very tiny quantities not expected to pose much of a risk.

6 – Free Radicals and Vaping

What the Report Claims

“E-cigs may expose users up to 1,000 times the levels of some damaging free radicals as cigarette smoke”

What the Evidence Really Says

This one really shows the quality of the research underpinning this foray into the world of anti-vaping extremism. The report references a study which found that levels of free radicals in e-cigarette vapour were 100 to 1,000 times lower than in cigarette smoke.

It seems that reading the studies you’re referencing is just too much work when you’re putting together a report like this. The end result is the free radical content of e-cig vapour being overstated by a factor of a million.

7 – Vaping is Linked to Lung Problems

What the Report Claims

“E-cig use is already linked to a higher risk of lung problems. Young e-cig users are far more likely to suffer with asthma or bronchitis than non-users.”

What the Evidence Really Says

This statement is – as far as we can tell – completely and utterly unsupported by evidence. The citation leads to a news article describing an unpublished study with the headline: “Electronic cigarettes may cause, worsen respiratory diseases, among youth, study finds.”

So what did the study find?

40 % of “particles” emitted by e-cigarettes can reach the deepest area of a youth’s lungs. This doesn’t mean e-cigarettes are linked to a higher risk of lung problems. The report also ignores other evidence suggesting improvements in lung function in smokers who switch.

Dr. Polosa has conducted several studies on the effects of e-cigs on the lungs, and comments on the report’s claim:

“The evidence shows the opposite – there is now scientific evidence showing improvements in subjective and objective asthma/COPD outcomes.”

8 – Won’t Everybody Please Shut Up About the Children?

What the Report Claims

“E-cig use among U.S. youth doubled between 2011 and 2012. And studies show young e-cig users are more likely to take up cigarettes use.”

What the Evidence Really Says

Well, we all knew The Children (TM) would come up at some point. In case you’ve been living under a rock with no wi-fi for the past five years, here’s the short version.

The CDC has a remarkable talent for drumming up concern about youth e-cigarette use while simultaneously providing no concerning evidence whatsoever.

The CDC’s approach to vaping works like this:

  • Define “current vaper” as “had even one puff of an e-cigarette in the past 30 days,” even though evidence shows most youth past-month vapers aren’t regular users.
  • Ask a bunch of middle and high school children about their vaping habits (but not about whether they used an e-cig with nicotine).
  • Be shocked when the rising use of e-cigarettes in society is also reflected in youth.
  • Get as close to saying “e-cigarettes are gateway to smoking” as possible without actually uttering the words.
  • Never comment on the probable role of e-cigarettes in the rapid decline in youth smoking.
  • Wait until next year and repeat steps 1 to 5, oblivious to the ethical and scientific problems with what you’re doing.

If you want a thorough take-down of the CDC’s approach to vaping, a risk communication expert did an absolutely spectacular job of this last year.

Explicit gateway effect claims are a different beast, but similar problems exist.

In a nutshell, the evidence claimed to show a gateway effect isn’t capable of even finding one. We’d need several very carefully designed studies to thoroughly prove there isn’t a gateway (as discussed in an interesting paper by Carl V. Phillips). However, there is every indication that e-cigs are not a gateway to smoking.

However, one issue is striking.

While we’re overloaded with anecdotal reports of smokers quitting their lifelong habit thanks to e-cigarettes, we’re yet to come across a single anecdotal report of e-cigarettes actually serving as a gateway to smoking.

That doesn’t mean it isn’t happening, but it’s a pretty crushing blow to the idea that we should be particularly concerned about it.

If it’s causing such a huge problem in society, why can’t people like Jason Kennedy find even one example?

9 – E-Cigarettes Aren’t Proven to Reduce Your Exposure to Toxins

What the Report Claims

“Vaping advocates claim e-cigs expose fewer people to lower levels of toxins. This hasn’t been proven. In fact, the opposite seems more likely. […] The truth may simply be that e-cigs expose you to different toxins than cigarettes do.”

What the Evidence Really Says

At this point, the report is basically making stuff up. It’s effectively saying that the multiple studies over almost an entire decade consistently showing much lower levels of toxic chemicals in e-cigarette vapour don’t exist.

You may have thought Igor Burstyn did a stand-up job of reviewing the studies on the chemistry of e-cigarette vapour, but the report seems to think that all of his citations are completely made up. You might have read Public Health England’s or the Royal College of Physicians’ reports – which cite several such studies – but according to this new report, they were just completely making up all of this research too.

Let’s drop the act: there are studies showing this. There are loads of them. Here, here, here, here, here, here, here and here. This barely scratches the surface.

Not only do we know the vapour contains less toxic chemicals, we also know that people who switch to vaping are actually exposed to less of them too. The report’s claim couldn’t be more wrong if it tried.

10 – Vaping Causes More People to Smoke Than it Helps Quit

What the Report Says:

“Scientists at the University of California found vaping may lead more people to take up smoking than to quit.”

What the Evidence Really Says

No prizes for guessing who one of the “scientists” referenced is. Here’s a clue: it rhymes with ANTZ.*

Aside from the gateway claim (see point 8), the idea here is that e-cigarettes really aren’t that effective for quitting. But yet again any honest research on the topic shows this to be categorically false. Despite limited evidence, a Cochrane review of the evidence on e-cigarettes for quitting smoking concluded that they do help smokers quit.

The Royal College of Physicians’ report points to evidence from the UK showing that vaping is very effective for quitting smoking. It even classes using an e-cig alongside behavioural support as being among the most effective approaches.

Riccardo Polosa also emphasises the huge potential value of vaping in bringing down the smoking rate, and points to evidence of this happening already in both the US and UK:

Vaping is the way to go. Population data from the US and UK show that the popularity of electronic cigarettes (EC) has contributed to an accelerated decline in smoking prevalence in these countries. In particular, recent data from the Office for National Statistics in the UK indicate that 850k ex-smokers are currently using ECs (equivalent to a whopping 39% quit rate) and a further 720k ex-smokers used them in the past but no longer. EC use may be valuable in aiding smoking cessation and preventing relapse.

But the report ignores all of this.

Instead, it references Stanton Glantz, who has a habit of using studies which are incapable of assessing whether e-cigs help smokers quit as a justification for claiming that they reduce your chance of quitting. This tactic has been torn to pieces very effectively here and here, if you’re interested.

Why the Misinformation?

So we’ve been through every key claim made by the report, and found everything from the usual over-stating of potentially concerning results to flat-out denial of the existence of huge swathes of research. Far from “published evidence exposing mainstream cover-ups,” a more accurate subtitle would be “published evidence being misinterpreted to serve ideological goals.”

The million pound question is why.

Is it purposeful deceit?

Was their research so awful that they honestly read “1,000 times less” as “1,000 times more” and never bothered to double-check?

Did they read the PHE or RCP reports on vaping? Or did they simply repeat whatever nonsense they heard about vaping in the news without even bothering to conduct any research?

I’d like to say it’s all due to ignorance, but they did add this little gem of an understatement to the end of their screed of misinformation:

In some ways, e-cigs may be somewhat ‘healthier’ than tobacco.

Really?

Well it would have been useful if you’d found the time to share the information that led you to that conclusion. Because all we got was well-worn, long-refuted anti-vaping talking points and an implied sneering disapproval of people who quit smoking using a technology you don’t like.

We’d like to thank Riccardo Polosa for all his help with the post and his illuminating comments addressing the report’s various claims.

*ANTZ: Term used for those anti-ecigarettes.

Also see:

19 E-Cig Studies Exposed As Junk Science

Leave a comment:

6 thoughts on “‘The Dirty Secrets of Those “Healthy” E-Cigarettes’ – Debunked

  1. “Why, contrary to all available evidence, do people believe that e-cigs are as dangerous as combusted tobacco?”

    Probably because dickheads keep saying “we just don’t know” whether or not they cause diacetyl popcorn cancer.

        1. But we’d conveniently forget to point out that cigarettes cause another obstructive lung disease quite frequently? Or that diacetyl has led to lung problems outside of the context of cigarettes? Or that the “750 times” figure only applies to people vaping 1 ml per day (i.e. nobody)?

          And we wouldn’t worry about any vapers who decide they might as well continue to vape diacetyl-containing liquids on the basis of misinformation?

          Personally I’d rather stick to the facts as best I can. Then people are free to make an *informed* decision about what they vape.

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