What is the difference between Propylene Glycol (PG) and Vegetable Glycerin (VG)?
Is e-juice/e-liquid safe or harmful?
What are allergies and side effects of e-juice/e-liquid?
What is the difference between Propylene Glycol (PG) and Vegetable Glycerin (VG)?
Is e-juice/e-liquid safe or harmful?
What are allergies and side effects of e-juice/e-liquid?
In January, The New England Journal of Medicine published a research letter by a group of Portland State University scientists who’d detected worrisome levels of carcinogens in some “vaping” gases. The backlash was almost instantaneous, with columnist Joe Nocera of The New York Times writing only days later that the letter can lead to conclusions that are “highly misleading.”
The criticism has continued. As Lynne Terry of The Oregonian/OregonLive reported last week, the journal Addiction published a letter to the editor advocating the retraction of the PSU gang’s research letter, which The New England Journal of Medicine has declined to do. The lead PSU scientist, meanwhile, dismissed critics as allies of the e-cigarette industry. And on we go.
So, what’s a vaper – or, more importantly, a smoker considering the switch – to think? While the retraction demand seems more than a little overheated, critics are right to feel at least a bit aggrieved. The research letter could not have been written more effectively to make casual readers stumble into an unjustified vape panic. And what drives public debate and policy, sometimes in unproductive directions, is the public’s understanding of scientific research, which is often incomplete.
The PSU researchers simulated vaping at low- and high-voltage settings consistent with those on a type of commercially available vaping device. Gases produced on the low-voltage setting contained no detectable level of formaldehyde-producing agents. Those produced on the high-voltage setting did, and the researchers reasoned that consistently sucking on a vaping device on the high-voltage setting would create a formaldehyde-related cancer risk up to 15 times as high as smoking conventional cigarettes. Naturally, the high-voltage data dominated the subsequent public debate even though low-voltage vaping produced less of the formaldehyde gunk than smoking conventional cigarettes.
It seems unfair to criticize the PSU researchers for their data. They found what they found. Entirely missing, however, was the sort of context without which informed policy debate cannot happen. The study’s primary critics pointed out that vapor tends to taste awful when generated at the high temperatures responsible for formaldehyde formation, which leads to real-world behavior (like not inhaling and adjusting the voltage setting) likely to prevent harm.
This observation, naturally, produced another back-and-forth. The PSU scientists argued that flavorants in vaping liquid can mask harsh flavors. Critics responded that the phenomenon is reported by people using flavored products, which certainly calls the masking argument into question. You can almost hear the hissing and growling, but the critics do have a point: Extrapolation of lab results to the real world should be done with great caution, yet extrapolation of the PSU study occurred with wild abandon. Such extrapolation was entirely predictable, yet nothing in the research letter published in The New England Journal of Medicine discouraged it.
Such misreading matters, ultimately, because it can affect individual behavior and public policy. As Nocera and others have argued, smokers considering a switch to the likely less harmful practice of vaping might be dissuaded if they believe mistakenly that they’ll consume toxic levels of formaldehyde. The interest of public health is not served in this case.
Likewise, the anti-tobacco establishment is all too eager to latch onto any argument, no matter how weak, to justify policies that treat vaping as if it were smoking. The National Park Service announced this week that vaping will now be prohibited in no-smoking areas – including those in the open air.
While insisting that The New England Journal of Medicine retract the PSU researchers’ letter may be silly, the controversy may yet prove useful. PSU chemists recently won a $3.5 million federal grant to study e-cigarettes. When they present their findings, as they will eventually, they should do so to the extent possible in a manner that will preclude the sort of criticism they earned with this year’s research letter. The lesson for the rest of us, meanwhile, is to read those findings – like other scientific findings – without rushing irresponsibly to questionable conclusions.
If you followed the news this week, you might think that teens who try electronic cigarettes are bound to take up Marlboros too. “Yep, e-cigarettes are a gateway to smoking,” read a news story published by the Fred Hutchinson Cancer Research Center. “Teens who vape appear more likely to smoke” was the headline at Reuters, and CBS Boston ran a story titled “E-Cigarette Smoking Gateway To The Real Thing, Study Finds.”
This is what happens when 16 people are made to represent an entire population.
Those headlines were reporting on a study published Tuesday in the journal JAMA Pediatrics in which researchers asked volunteers ages 16 to 26 a series of questions on two occasions, a year apart.
On the first survey, 694 people answered “definitely no” when asked the following: “If one of your friends offered you a cigarette, would you try it?” and “Do you think you will smoke a cigarette sometime in the next year?” The researchers deemed these respondents “nonsusceptible.” Importantly, some of these respondents said they had used e-cigarettes.
A year later, those same 694 participants were surveyed again, and this time, 37.5 percent of the original e-cigarette users said that they’d gone on to smoke traditional cigarettes. That’s a big percentage considering they weren’t supposed to be susceptible, especially when you consider that only 9.6 percent of the respondents who hadn’t tried e-cigs before that first survey had taken up smoking during the same time period.
The buzziest finding: Compared with people who hadn’t used e-cigarettes before the first survey, those who had were about eight times1 as likely to progress to trying a tobacco cigarette by the time of the second survey.
Those startling numbers — an 8x multiplier and 37.5 percent conversion rate — were the kind that made their way into the journal’s press release and the news stories. And as press releases go so goes overhyped journalism. If only the numbers were worthy of the headlines.
To understand why they’re not, let’s look at where that big 37.5 percent number comes from. All those “nonsusceptibles” who said they had tried e-cigarettes on the first survey? There were only 16 of them (2.3 percent of 694). And a grand total of six of those 16 people started smoking during the one-year period between the first and second surveys. Voila, six out of 16 makes 37.5 percent — it’s a big number that comes from a small number, which makes it a dubious one.
So because six people started smoking, news reports alleged that e-cigs were a gateway to analog cigs. The study could have just as easily been framed another way: Ten times as many people who hadn’t vaped became smokers as those who’d used e-cigarettes. (Sixty-five of the 678 “nonsusceptibles” who had never vaped eventually took a puff of a traditional cigarette.)
The study’s lead author, Brian Primack, a professor at the University of Pittsburgh School of Medicine, told me that given the “statistical significance” of the results, it’s OK to draw conclusions. In medicine, he said, scientists often base an entire finding on a small group. “We’ll find that seven people had a heart attack in this group and only four had a heart attack in this group, and based on that, we will forever say that you should take Lipitor,” he said. He wasn’t expecting the small sample in this study to yield statistically significant results, but after analyzing the data in numerous ways, “it was all just very consistent,” Primack said. “We think we really are getting a signal here.” If the peer reviewers had decided they couldn’t base their conclusions on 16 people, “then that’s their prerogative,” Primack said, but the paper was accepted by the journal.
I asked Andrew Vickers, a statistician at Memorial Sloan Kettering Cancer Center, to take a look at the analysis. He said it wasn’t surprising that there was an association between e-cigarettes and smoking. The real question is how big it is. While this study suggests that the effect is large, Vickers found reason for caution in what statisticians call the “confidence interval,” a plausible range of values for the study results. The confidence intervals here are “ridiculously wide,” he said, which means that the estimate that e-cigarette users are about eight times as likely to take up smoking as non-users is just a rough approximation — the true increase in risk could be anywhere from 30 percent to 5,700 percent.
Whether vaping provokes kids to start smoking or is just another novel thing for would-be smokers to try remains unclear. The number of kids and teens using e-cigarettes is still small — less than 4 percent of middle-school and 14 percent of high-school students have tried the devices, according to the latest report from the Centers for Disease Control and Prevention.
Primack’s small study is just one sliver of information in a complicated body of evidence on the effect of e-cigarettes. Numerous studies have looked at the relationship between e-cigarette use and smoking, and several have found that smoking rates were higher in e-cigarette users than in non-users. Yet other studies have suggested that e-cigarettes may help smokers quit, and a recent U.K. government report concluded that e-cigarettes may reduce smoking, even in those not intending to quit.
The media does the public no favors when it presents a single study (especially a small one like this) as gospel, rather than just a small addition to the amassing evidence. After spending more than 40 minutes on the phone with Primack, I’m convinced of two things — his intentions were noble, but his study does little to answer the question at hand: Are e-cigarettes a gateway to smoking among kids and teens? Even if the numbers in the study were larger, statistical analysis can’t tell you whether the data you collected is the right data for answering your question. Here the answer is clearly no. The survey’s respondents weren’t all fresh-faced adolescents, many were older teens and 20-somethings (the average age of those who’d tried e-cigarettes was 19.5), and it’s not possible to verify the accuracy of their self-reported smoking histories.
When I asked Primack whether he agreed with the headlines touting his study as proof that e-cigarettes are a gateway to smoking, he hedged. The press tends to get dramatic, he said. “Yeah, it might be, I guess, a little bit overblown, but on the other hand, not that overblown because we’re starting to get a few different studies showing the same thing,” he said. For instance, he pointed to a study published last month showing that high school students in Los Angeles who used e-cigarettes had higher smoking rates than non-users.
It’s plausible that young people who try e-cigarettes might also take up smoking (especially after becoming habituated to nicotine). But as Primack himself pointed out to me: The respondents in his study are not a nationally representative sample. Are the experiences of those 16 e-cigarette users typical? We don’t know. But uncertainty doesn’t make for sexy headlines.
This is just bad journalism and NO FACT CHECKING and outright lying .
It has been promoted as healthier than smoking cigarettes, but now, experts said they know what is really in E-cigarettes — and it’s not pretty.
Experts said the levels of dangerous chemicals is shocking.
Vape stores are popping up all over the place in the Bay Area. And now, there is an effort to change what is on the label.
Vaping is the trendy new way to get a nicotine fix through an electric cigarette. And KRON4 has found people prefer puffing them over cigarettes.
But what is in them could kill you.
Oakland-based watch group, The Center for Environmental Health, has now taken legal action to hold e-cig makers accountable for failing to alert consumers about what is really going in their body.
“Our study showed high levels of formaldehyde…,” Center for Environmental Health spokesman Charles Margulis said. “These are cancer causing chemicals and linked to many other serious health problems.”
In one e-cig , the study showed the level of formaldehyde was more than 470 times higher than the California safety standard.
Particularly troubling, to the CEH, because teens are turning to vaping over traditional tobacco.
“There is almost 14 percent of high school students using e-cigs,” Margulis said. “They clearly do not know how dangerous they are.”
Which is why the group has taken legal action to clearly label e-cigs about the dangers, so the message of what’s really in there doesn’t go up in smoke.
Wander into a vape shop in the mall or online, and you can find a smorgasbord of flavors: cotton candy, vanilla custard, even Unicorn Milk or Katy Perry’s Cherry.
Flashy flavors have helped e-cigarettes, designed to vaporize a nicotine solution, grow into an industry with an estimated $3.5 billion in annual U.S. sales. Less than a decade after the battery-powered devices were introduced in the United States, an estimated 10 percent of American adults and 13 percent of high school students “vape,” according to recent surveys. While many users perceive e-cigs as safer than traditional cigarettes, some of the flavorings that make them so enticing may have their own toxic consequences.
A growing number of studies find that some of the liquids used in e-cigarettes contain flavorings whose inhalation has been associated with lung problems, ranging from irritation to a rare but serious lung disease. For example, diacetyl, a butter-flavored chemical, has been linked to dozens of cases of bronchiolitis obliterans, a life-threatening obstructive lung disease.
E-cigarettes are unregulated, but that may change. The Food and Drug Administration is considering a rule to extend its cigarette-regulating authority to e-cig devices. More than 7,700 e-cig flavors are being sold under more than 450 brands, with no labeling or testing requirements.
Jessica Barrington-Trimis, an epidemiologist at the University of Southern California who studies tobacco’s health effects, said that flavorings are particularly worrisome because they “have a history of being known respiratory toxins.” Barrington-Trimis, who spoke at an FDA panel looking into e-cigs in March, said that because the devices produce an ultrafine aerosol that goes deep into the lungs, their flavorings “are a natural target” for further investigation. “We need to research this more to understand what chemicals are in these things and what these chemicals may be doing to the lungs of the user,” she said.
One of the first people to highlight e-cig flavoring concerns was a physician who uses e-cigarettes himself. Konstantinos Farsalinos, a researcher at the Onassis Cardiac Surgery Center in Athens, tested 159 sweet e-cig liquids, such as toffee, chocolate and caramel flavorings, and found that 74 percent of the samples contained diacetyl — the chemical associated with bronchiolitis obliterans — or a chemically similar substitute, acetyl propionyl. Among the ones that tested positive, nearly half would expose users to levels that exceed recommended workplace limits for breathing the two chemicals, his 2014 study found.
Diacetyl is found naturally in butter, beer and other foods, and it is added to baked goods, candy and snack foods to impart a buttery or creamy taste. Although it is considered safe to eat, breathing it may not be.
In 2002, the National Institute for Occupational Safety and Health, reported that eight workers in a Missouri microwave popcorn plant had developed bronchiolitis obliterans after breathing diacetyl on the job. Half of them needed lung transplants, and five have died of respiratory causes, Kathleen Kreiss, a NIOSH expert in occupational respiratory disease, said in an e-mail.Dozens of cases of bronchiolitis obliterans — known in some circles as “popcorn lung” — have since been found at other food and flavorings plants.
Farsalinos, who has accepted some funding from the vaping industry, said he believes that e-cigarettes are safer than tobacco cigarettes. Acetyl propionyl and diacetyl are also naturally present in cigarette smoke, Farsalinos said, at levels higher than those he found in e-cigs.
Still, Farsalinos said, “these specific chemicals should be completely removed” from e-cigs. “Why? Because it’s a 100 percent avoidable risk.”
Some manufacturers avoid diacetyl. For example, Nicoventures, a division of British American Tobacco, does not use diacetyl in its nine e-cigarette flavorings, Sandra Costigan, a company toxicologist said in an e-mail.
The American Vaping Association, an advocacy group for the industry, believes that diacetyl and acetyl propionyl should not be added to e-cigarette flavorings, association president Gregory Conley said.
In 2012 the Flavor and Extract Manufacturers Association, which represents the U.S. flavorings industry, issued a list of 27 “high-priority” flavoring chemicals that, while safe in food, may pose a risk of respiratory injury and for which it recommends reducing inhalation exposure. The list includes chemicals found in e-cig liquids, such as diacetyl and benzaldehyde, which is used in almond and cherry flavors.
“When we saw flavors were being used in e-cigarettes, we wanted to put the word out right away that it’s a possibility that flavors being inhaled through an e-cigarette could also be harmful,” John Hallagan, the association’s senior adviser and general counsel, said in an interview.
“Flavors are not made to be inhaled,” he said. “In the absence of safety information, what we’re saying is we really need to pay attention to this from a safety perspective.”
A 2013 study found that several cinnamon-flavored e-cig liquids contained a chemical, cinnamaldehyde, that researchers said was highly toxic to human cells in lab tests. A co-author of that study, Prue Talbot, a professor of cell biology at the University of California at Riverside, said the results corroborated online reports by e-cig users of problems related to cinnamon flavors, including swollen throats and mouth sores.
Another study examined 30 e-cigarette liquids and found that many flavors — including a cotton candy, a bubble gum and a French vanilla — contained aldehydes, a class of chemicals that can cause respiratory irritation, airway constriction and other effects. The 2015 paper described two flavors, a dark chocolate and a wild cherry, that would expose vapers to more than twice the recommended workplace safety limit for the aldehydes vanillin and benzaldehyde. Different brands and even different batches of e-cig liquids can contain different amounts of flavoring chemicals.
“There’s no going by the flavor names as to say what’s in it,” said James Pankow, a chemistry and engineering professor at Oregon’s Portland State University, one of the co-authors of the study.
The FDA’s proposed rule on e-cigarettes would restrict sales to young people and prohibit unsubstantiated health claims. If e-cigs are brought under the FDA’s regulatory authority, the agency would have to go through additional rulemaking to set standards on flavorings, FDA spokesman Michael Felberbaum said in an e-mail. The FDA prohibits adding flavorings, other than menthol, in traditional tobacco cigarettes.
Some e-cig companies are doing their own research on flavorings. Nicoventures, the British company, recently proposed a screening process to avoid liquid flavorings that are classified as respiratory allergens, carcinogenic, mutagenic or toxic to reproduction, among other criteria. The company has rejected diacetyl and acetaldehyde as flavorings and avoided developing a flavor that uses cocoa shell extract because of concerns that it might be a respiratory sensitizer, Costigan said in an e-mail. “We wanted to demonstrate that they [flavorings] could be used responsibly even when there are limitations in data,” she said.
The company says that flavorings benefit public health by helping smokers transition away from combustible tobacco. However, the science isn’t settled yet on whether e-cigs help people quit tobacco cigarettes — or get them hooked. A recent study, for instance, found that ninth-graders who used e-cigs were about 2 1/2 times as likely as their peers to start smoking traditional cigarettes.
Conley, of the American Vaping Association, says e-cigarettes flavored with watermelon helped him stop smoking five years ago, and he will fight to keep flavorings on the market.
“There’s a reason why the gum, patch and lozenge have such pitiful success rates,” he said, referring to some common approaches to smoking cessation. “We have to avoid medicinalizing these products [e-cigarettes] and making them bland and boring,” he said.
Even if e-cigarette users are exposed to diacetyl, he asserted, the risk of harm is only a fraction of that from smoking tobacco, which causes 480,000 deaths per year in the United States, according to federal data.
Talbot, who conducted the cinnamon flavoring study, said the problem is that people are now “inhaling a product into their lungs, and we don’t currently know what the consequences or long-term health effects of that will be.” While it is true, she said, that e-cIgs contain fewer chemicals than the brew of 7,000-plus that are in traditional cigarette smoke, “it would only take one bad one.”
Public Health England (PHE), a government agency, recently published a detailed report on electronic cigarettes that describes them as far less dangerous than the conventional kind and recommends them as a harm-reducing alternative. “Encouraging smokers who cannot or do not want to stop smoking to switch to EC [electronic cigarettes] could help reduce smoking-related disease, death and health inequalities,” the report says. “Smokers who have tried other methods of quitting without success could be encouraged to try EC to stop smoking, and stop smoking services should support smokers using EC to quit by offering them behavioural support.”
PHE’s position should not be controversial. It is indisputable that vaping, which does not involve tobacco or combustion, is much safer than smoking, and it logically follows that smokers can dramatically reduce the health risks they face by switching. Yet public health agencies and anti-smoking organizations in the United States, unlike their counterparts in the U.K., are strangely reluctant to acknowledge these points, implausibly portraying e-cigarettes as a threat rather than an opportunity. The British example points the way to a calmer, more rational approach that is consistent with the public health goal of reducing the morbidity and mortality associated with smoking.
The PHE report, which was overseen by Peter Hajek, a professor of clinical psychology at the Wolfson Institute for Preventive Medicine, and Ann McNeill, a professor of psychiatry, psychology, and neuroscience at King’s College London, is very clear on the relative hazards of smoking and vaping:
While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals which are present pose limited danger. It has been previously estimated that EC [electronic cigarettes] are around 95% safer than smoking. This appears to remain a reasonable estimate.
The evidence concerning e-cigarettes’ effectiveness in helping smokers quit is more limited but promising:
Recent studies support the Cochrane Review findings that EC can help people to quit smoking and reduce their cigarette consumption. There is also evidence that EC can encourage quitting or cigarette consumption reduction even among those not intending to quit or rejecting other support. It is not known whether current EC products are more or less effective than licensed stop-smoking medications, but they are much more popular, thereby providing an opportunity to expand the number of smokers stopping successfully.
The PHE report warns that misinformation about e-cigarettes, including sensational press coverage of weak or overinterpreted studies, is warping public perceptions of the risks posed by vaping, possibly deterring smokers from making a switch that could save their lives. British surveys indicate that misperceptions have increased in recent years. A survey of adults sponsored by the British group Action on Smoking and Health—which, unlike the American group of the same name, supports e-cigarettes as an aid to quitting—found that the share of respondents who incorrectly described e-cigarettes as “more harmful” than tobacco cigarettes or “equally harmful” rose from about 8 percent in 2012 to 20 percent in 2014. Another 23 percent said they did not know.
The PHE report notes that American surveys have found a similar trend. In fact, public perceptions in the United States seem to be even more divorced from reality. According to a Reuters poll completed on June 4, just 35 percent of Americans understand that “e-smoking is healthier than traditional cigarettes.” The rest, nearly two-thirds, either disagree with that statement or don’t know.
“There is a need to publicise the current best estimate that using EC is around 95% safer than smoking,” the PHE report concludes. In this country, however, public health agencies and anti-smoking groups seem determined to obfuscate that crucial point.
“The long-term impact of e-cigarette use on public health overall remains uncertain,” says the U.S. Centers for Disease Control and Prevention (CDC), which calls e-cigarettes “tobacco products” even though they contain no tobacco. “When it comes to tobacco products,” says CDC Director Tom Frieden, “we really have to assume they’re dangerous until they’re proven safe, rather than the other way around.” Ron Chapman, director of the California Department of Public Health, calls e-cigarettes “a community health threat” and falsely claims “there is no scientific evidence that e-cigarettes help smokers successfully quit traditional cigarettes.”
The advice from private organizations that are ostensibly interested in reducing smoking-related harm is generally not any more helpful or accurate. The American Cancer Society asks whether e-cigarettes are “safe,” when the relevant question is whether they are less hazardous than conventional cigarettes, which they clearly are. “Because the American Cancer Society doesn’t yet know whether e-cigarettes are safe and effective,” it says, “we cannot recommend them to help people quit smoking.”
The American Lung Association (ALA) says it’s “a myth” that “e-cigarettes are safe” but does not address the relative hazards of smoking and vaping. The ALA also claims it’s a “myth” that “e-cigarettes can help smokers quit,” which is demonstrably false, as the PHE report shows. The ALA suggests that the continuing declines in smoking among American teenagers are “offset by the dramatic increase in use of e-cigarettes,” which is scientifically absurd given vaping’s clear health advantages over smoking.
American e-cigarette alarmists frequently argue that vaping is “renormalizing” smoking, luring nonsmokers into nicotine addiction, or serving as a “gateway” to smoking. The PHE report finds little or no evidence to support those claims:
Since EC were introduced to the market, smoking prevalence among adults and youth has declined. Hence there is no evidence to date that EC are renormalising smoking; instead it’s possible that their presence has contributed to further declines in smoking, or denormalisation of smoking. The gateway theory is ill defined and we suggest its use be abandoned until it is clear how it can be tested in this field. Whilst never smokers are experimenting with EC, the vast majority of youth who regularly use EC are smokers. Regular EC use in youth is rare.
The trends and patterns of use are similar in the United States, where public health officials nevertheless continue to warn that vaping will somehow lead to more smoking. Frieden asserts, contrary to all the evidence so far, that “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.” Frieden also bizarrely calls the decision to switch from smoking to vaping “a misconception,” as if the choice itself were scientifically incorrect, on par with declaring the world flat or attributing someone’s personality traits to the arrangement of stars in the night sky on his birthday.
Such misinformation can be lethal. “E-cigarettes are not completely risk free,” says PHE official Kevin Fenton, “but when compared to smoking, evidence shows they carry just a fraction of the harm. The problem is people increasingly think they are at least as harmful, and this may be keeping millions of smokers from quitting.” Although they claim to be interested in reducing smoking-related disease and death, e-cigarette alarmists like Frieden are actively undermining that goal.
This article originally appeared at Forbes.com.