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Interview with Paul Bergen: Are Electronic Cigarettes Safe? Setting the Record Straight…

Are Electronic Cigarettes Safe? Paul Bergen of the Alberta School of Health’s Tobacco Harm Reduction project clarifies the WHOs position, addresses the cessation issue and generally sets the record straight on how beneficial and safe E-Cigarettes can be… 
[ via E-Cigarette Direct ]

. . .

Q: How harmful is the E-cigarette, and how true are reports such as Put Down that E-Cigarette which claim that e-cigarettes could be poisonous?

A: That particular posting is somewhat misleading. The main concern WHO had regarding electronic cigarettes were that some distributors were inappropriately saying that WHO had endorsed them. Apart from that, like much of the other opposition to ecigarettes, WHO are also being inappropriate in concentrating not on whether these devices will actually get people to quit nicotine rather than whether they will reduce the harm associated with tobacco use.

The author of the posting, Summer Johnson, who specializes in bioethics, might be more cautious in her academic arena but she has previously posted that “Public health ethics says that almost any measures are okay to get smokers addicted to nicotine to kick the habit to stop inflicting harm on themselves and others.” (http://blog.bioethics.net/2008/09/say-goodbye-to-tobacco/). It is bad enough when activists say any measures against smokers are reasonable (in some places you can bar them from fostering children, holding jobs, or even their spouses being denied jobs) but it is much worse when professed ethicists say it.

However, this hardly needs responding since the comments on the blog show that most people can easily see that her piece was written without really learning anything about the topic. Her main error, common to most anti-tobacco activists, is that when you are discussing a harm reduction alternative what matters is not how absolutely safe a product is but whether it is safer than the comparison. Though there is not perfect certainty on how safe electronic cigarettes are, we are pretty certain that they are a lot safer than cigarettes are. (Oddly enough given Johnson’s statement about any measures to get smokers to quite being good, why is she not supportive of electronic cigarettes?)

Q: How does the electronic cigarette compare to real cigarettes?

A: Though not many good studies of electronic cigarettes exist yet, but of those that do, no negative health effects have been found. The devices are quite simple so there is not much to worry about. They are for the most part, traditional cigarettes with all the known dangers removed. And this is why we are quite certain they are much safer than smoking. The major danger in smoking has always been tobacco smoke, and that has now been removed.

What is left is a tube of some sort you put in your mouth (no danger unless you poke it in your eye or swallow it), nicotine (which is no more dangerous than caffeine unless you are a fetus), a flavoring component, and propylene glycol (which though toxic if you drink a lot of it is quite harmless if you inhale it). The possible harm is if something slips in with the nicotine and flavoring compounds.

We also now have a few years of population use and though you really need decades of use to be certain, at least we know nothing major and short term has appeared. The one reasonable concern is that there is little regulation on the manufacture of these devices and some might inadvertently harbor some potentially toxic contaminant (though it would have to be remarkably robust to approach the toxicity of cigarette smoke).

Q: Can it stop people smoking?

A: Personally I have seen it work, and not. And though I haven’t smoked tobacco in some time, I tried this and found it utterly satisfying to the point where I could not imagine real smoking any longer. And this was for a non nicotine version. For some people, smoking is not about the nicotine but about the pleasures of the physical act of smoking and for those, this is a godsend.

What is promising about this is that it is so similar to smoking that people immediately imagine it as supplanting their other habit. Most other alternatives require some getting used to, and rather than optimism, many start thinking about how it doesn’t do certain things. Whether most people will switch over completely is beside the point. Saving just a few lives is worth promoting a safer alternative. I suspect that e-cigarettes will actually end up having a major impact on smoking levels but as I said, though great, that is not required to promote this. Smoking is bad for you but it is still a choice; our job is not to make people quit smoking but to make safer choices so attractive or effective that they want to make the choice to move away from cigarettes.

I suspect that in time, people will investigate the quitting potential of ecigarettes but like all these studies, you need a few years to really know if it works. In the meanwhile, anytime someone is smoking an ecigarette they are not smoking something else which is a good thing.

If the usual quit smoking alternatives such as the gum and the patch were judged on how successful they were in long term quit rates, many people might argue that they should be taken off the market. There is a pressing need for better alternatives for smokers and to the distress of the anti-tobacco crowd the best and most effective alternatives in the market right now appears to be smokeless tobacco and electronic cigarettes. The former we have plenty of data that shows it is safer and that people can switch, and the latter less data but positive indications that it might end up as safe and maybe even more effective since it mimics smoking so well.

Q: What, in your opinion, is the reason behind the supression of information and testimonials by the Government?

A: Some cynics say that the government worries about losing tobacco tax revenues if everyone switched over to this product. I might be naïve but I do not think that is their motive (though since tobacco taxes have become prominent in many budgets it should be). At this time, I think it comes from two sources 1. simply that it is a product that confuses them because it does not fit neatly into a category (like for instance the Segway is illegal still in many places because no one quite knows where to put it; not that there is a motor industry conspiracy against it) and 2. some people in those positions are vehemently anti-smoking and will fight any product that makes smoking more acceptable.

As it is, the government can place barriers on the product, but information suppression is bound to fail given the internet. News sources are covering this well, and for the most part accurately and positively, so short of shutting down the presses, and the net itself, the government can interdict the product at borders, not allow the sale in stores etc but the information is still fairly free. (Not to say some haven’t tried; they do have the power to apply restrictions on commercial sites).

Q: Can you give us any further examples of the sale of/information about e-cigarettes being supressed?

A: As far as restricting the sales of e-cigarettes, right now the most famous example is Australia which has banned the sales on or off line of these products. A few countries like Finland allow the sales on line or for personal use but not for sale in stores. Others only allow the sale of ecigarettes as medical devices, and yet others allow the sale but do not allow any advertising of the product. What we might see is a “Swedish” example emerging, that is a country that does not stand in the way of this alternative, and where the alternative becomes as available and more popular that cigarettes, and then over time a decrease in all the smoking related conditions. If it is anything like the smokeless tobacco case, that won’t ensure any spread of the solution but at least it would furnish good evidence that this could work.

Q: What misinformation has been spread about e-cigarettes?

A: There is not a lot of misinformation about e-cigarettes in comparison to smokeless tobacco. The one fear some mention is about unknown contaminants. This is probably partly based on the Chinese origins of the product. The only major source of this fear appears to be WHO who did not actually say it was true but said that there were no studies to rule out the possibility. This is not entirely unreasonable. Though the potential is not strong enough to warn smokers away from this product, given the many producers and lack of regulatory oversight, there is little real quality control in the production of this product. Of course, once the WHO said that, journalists who thrive on spreading fears, turned this into various headlines about poisonous products. However, there is more skepticism about this reporting than most fear reporting such as the various food scares.

Q: What damage is being caused by the supression of e-cigarettes?

A: I don’t think the “suppression of information” is that effective or influential but rather the lack of the product being commonly available. We need these products to be sold where other tobacco products are sold and to be seen on the streets and in the bars and on planes and anywhere smokers might notice them, and then consider switching.

. . .

Be sure to check out the Tobacco Harm Reduction Project’s Electronic Cigarette FAQ section for even more useful  information.


12 comments for “Interview with Paul Bergen: Are Electronic Cigarettes Safe? Setting the Record Straight…”

  1. e-Cigs are a great benefit for all those, that live with addiction to nicotine.
    Dyspneu and cough are no longer present after a few weeks.
    People will feel themselves more powerful.
    If goverments feel responsible to their populace, they would not only allow e-smoking, they will support it.
    People with a nicotine-addiction are more active in conversation than not addictive.
    Addiction with a good effect for society, if discussion and community are wished.
    Those societies that are going into a dictatorship will have fear against all people, that are coming together to talk and feel as a community.
    In a democracy the effects of smoking are considered useful, the use of e-cigs should be recommanded, to leave the profits of nicotine for society and quit the risks of fire-gases.

    Ask e-smoking people!
    They all feel much better after only three ore four weeks!

    Use common sense!
    At “http://www.vinirette.de” the combination of indregients in smoking fluid is totally published.
    All parts of the depots (exept nicotine) are mentioned in the “GRAS-List”. (Generally recognized as safe) from FDA.
    FDA says that e-cigs have no other risk, execpt nicotine, all other substances are recognized as save.
    Those people that are trying to bann e-cigs from the market will feel guilty, not avoidig lung cancer, apoplexia and myocardial infarction.
    As an Information:
    I am a physician, specially taking care to patients suffering lung deseases.

    Posted by Michael Blumenstein | April 10, 2009, 7:41 am
  2. wow e-cig luv, you really should have finished the site before you spammed it as a comment.

    (editors note: e-cig luv’s comment was flagged as spam and removed, thanks for pointing this out Mr. Brown)

    Posted by Mr. Brown | April 14, 2009, 10:24 am
  3. All this brouhaha over whether e-cigs being promoted (or not) as a smoking cessation device. All I know is, I had no INTENTION of quitting cigarettes. I purchased an e-cig because I became fed up with the constant increase in cigarette prices. It was a “happy accident” to discover that the e-cig was enough of an alternative to smoking that I’d no longer desire a cigarette. If the government was HALF as concerned about the ill effects of cigarettes as they’re becoming with e-cigarettes, we’d have a few less people dropping dead on a daily basis. Here’s hoping the regulatory factions will wake up and smell (or not) the vapors.

    Posted by Rip Washington | April 19, 2009, 2:57 am
  4. Right on Rip, we agree. The ESM motto: “Keep Smoking!”

    Posted by ESM Editor | April 19, 2009, 1:30 pm
  5. We have been using the e-cigarette for awhile now. What is the difference between the nicotine inhaler and e-cigarette? Nothing but who is going to profit. We need to think of our love ones profit and not the bottom dollar. I enjoy helping people and I love this product. We need to stand together and tell all our loved ones about this product. Let the people decide.

    Posted by laverne | April 29, 2009, 2:12 pm
  6. hard to ignore health benefits of switching to the Electronic Cigarette isn’t reason enough to make you give up on your tobacco cigarettes, maybe saving some money will help sway your decision.

    Posted by tibi | May 12, 2009, 12:21 pm
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  8. Reprinted from Todays’s Baltimore SunPaper. It is a fair and infomative article (nice for a change).

    Fake cigarettes, fake smoke, real nicotine. Some debate advantages of electronic smoking device.

    By Stephanie Desmon | stephanie.desmon@baltsun.com
    May 18, 2009

    From a distance, it looks like Tal Broustin is lighting up a cigarette, right in the middle of Arundel Mills, a clear no-no. And he is trying to get others to take drags, too, luring passersby to his kiosk by asking if they are trying to quit smoking.

    Up close, it is clear that Broustin is taking puffs not from an actual cigarette, but from a battery-powered gadget designed to look like the real thing. Called an “e-cigarette,” or electronic cigarette, it contains no tobacco, gives off no smoke but instead is a nicotine delivery device that gives off heated water vapor. Some companies are pitching e-cigarettes simply as less harmful alternatives to smoking, saying that smokers who can’t quit might be better off “vaping” one of their products. Other companies, though, are selling their e-cigarettes as smoking cessation tools, claims that have not been backed up by any science.

    Regardless, the relatively new devices – available online, at truck stops and at mall kiosks like the one where Broustin works – are drawing fire, mostly from groups such as the American Cancer Society and the American Lung Association, and from scientists who say they fear the products may pose unknown dangers, even if they’re not from the known carcinogens in cigarette smoke.

    Some have called on the Food and Drug Administration to ban them immediately. The FDA says e-cigarettes are “unapproved drug-device combinations,” and, in the past two months, has detained 17 shipments from China at the border and sent them back. “We don’t know its safety profile,” said spokeswoman Karen Riley.

    Related links
    The electronic cigarette Photos Despite the recent FDA actions, the industry says more than 100,000 e-cigarettes have been sold in the United States, and the number grows every day.

    “Relatively little is known about how they’re used, how much nicotine gets into people, what other chemicals are coming along for the ride,” said Dr. Jonathan Samet, director of the Institute for Global Health at the University of Southern California and a former department chairman at the Johns Hopkins School of Public Health in Baltimore. “To make a therapeutic claim, you need to do the proper testing.”

    One selling point of e-cigarettes is that they can be used where smoking is banned – in bars, in restaurants, at the mall. Samet said he thinks people who use them could get even more nicotine than before because they will be able to “light up” in more places. One consequence of smoking bans, he said, has been that more people have quit smoking.

    Jack Leadbeater, chief executive officer of NJOY, a Scottsdale, Ariz., e-cigarette maker, is chairman of the E-Cigarette Association. The industry group includes many of those who sell the products, though it doesn’t include Smoking Everywhere, the company whose kiosk is at Arundel Mills and other malls. He says his association’s members make no claims that their device will help people quit smoking.

    “It’s really sold just as an alternative to allow current smokers to get nicotine in a manner that’s more palatable,” he said. “If this was a form of vodka that didn’t cause liver damage, would we be having the same sort of problems?”

    A starter e-cigarette kit typically goes for about $100. When the user inhales through the cigarette-like tube, a heating element is activated and it vaporizes a nicotine solution stored in the mouthpiece. A red light will glow on the end, simulating the burning of tobacco. The mouthpiece contains about the same amount of nicotine in a pack of cigarettes and is flavored to taste like tobacco or menthol (though some offer mint, vanilla or other flavors). The nicotine needs to be replenished at an additional charge.

    William T. Godschall, executive director of Smokefree Pennsylvania, said he finds the debate about e-cigarettes to be counterproductive. He agreed that clinical trials have not been conducted, but he finds it odd that a government that can’t seem to regulate cigarettes – which are known to cause cancer – is upset over a much less hazardous product.

    “These e-cigarettes are at least 99.9 percent less deadly than cigarettes,” he said. “Let’s worry about the products that are actually killing people.”

    Back at the Smoking Everywhere mall kiosk, Broustin is closing in on a sale. He has blown vapor into the air to show James Papanicolas, a 19-year-old mover from Laurel, that it doesn’t stink like cigarette smoke. He has explained that his product can actually help reduce nicotine addiction by allowing a smoker to choose less and less concentrated amounts of the drug over time.

    Papanicolas’ friend, Rose Sanders of Taneytown, isn’t sold. The 27-year-old doesn’t understand how an e-cigarette could ease her addiction. “It’s still going to make you want another cigarette,” she said. “If you have this, you’re still thinking about smoking.”

    But Papanicolas planned to buy the e-cigarette. He thinks it will save him money in the long run, since the new filters cost far less than the $6 to $8 he shells out for a pack of Newports.

    Will it help him stop smoking? “It might,” Papanicolas said. “I know it will help me stop buying cigarettes.”

    Posted by benz8275card | May 18, 2009, 4:05 am
  9. Here is what I see as the major hurdle the media is having, and this does not just pertain to Electronic Cigarettes. They never seem to ask the right questions. They are always asking, “Are Electronic Cigarettes Safe?” And this usually leads to the comment that being that it is such a new product, there has not been ample time to fully determine their safety. Or, more often than not, it comes out that they are not safe.

    They need to ask questions more from a smokers point of view! Smoker are already smoking tobacco cigarettes which they KNOW are not safe. So what the media should be asking, and what all smokers want to know, is “Are Electronic Cigarettes safer than tobacco cigarettes?” That is what is important. They are already using tobacco cigarettes which cause all sorts of cancers and other problems, so they simply want to know if it e-cigs are safer than what they have been using.

    Most people who have switched to the Electronic Cigarette will easily contest that they feel much, much better.

    Posted by Kevin | July 30, 2009, 6:10 am
  10. I quit smoking using e cigarettes, and i simply have never been able to quit for more than a week before this.

    Posted by E Cigarette | December 29, 2009, 7:53 pm
  11. I am e-smoker since January, 2010 and I feel definitely better without tabacco cigarettes in the vital spark .

    Posted by ecigarea | June 21, 2010, 10:20 am
  12. I am e-smoker since January, 2010 and I feel definitely better without tabacco cigarettes in the vital spark .

    Posted by ecigarea | June 21, 2010, 10:20 am

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