WHO discredits e-cigarette by suggesting that tobacco cigarettes are safer because they have a filter

 

By Dr Konstantinos Farsalinos

In an unprecedented statement on Philippines national television (watch the video), Dr Florante Trinidad, technical officer at “Tobacco-Free Initiative”-WHO Western Pacific Region, suggested that electronic cigarettes are more dangerous than tobacco.  He mentioned: “The most dangerous thing about this product (e-cigarette) is that the nicotine goes directly to the lungs while regular cigarettes have a filter. With this delivery device (the electronic cigarette) the nicotine goes directly to the lungs.”

            This is a previously-unheard statement. For the first time, a WHO official is publicly and directly suggesting to e-cigarette users (vapers) that it is safer to go back to tobacco cigarettes. Everyone who has seen this video got the same impression. The biggest issue is that this statement is scientifically false, misleading and dangerous for the health of e-cigarette users who may be intimidated and relapse to smoking.

 

Where is the truth in this statement?

The truth is that, indeed, tobacco cigarettes have a filter. But, 1 cigarette contains 10mg of nicotine (or more). Some of it is destroyed by heat, some is filtered and the rest is inhaled. The information on the packs of cigarettes refers to the amount of nicotine present in the smoke, by using specific conditions of smoke production (35ml puffs, one puff every 60 seconds). Studies have found that this method underestimates true nicotine delivery by 2-fold. I have shown that in order to consume amount of nicotine similar to 1 cigarette you need at least 21mg/ml nicotine-concentration liquid (without a filter!).

It is much more important to know how much nicotine is absorbed (rather than consumed) by the user. It is not true that nicotine is absorbed from the lungs when using e-cigarettes. In fact, we are not sure if nicotine is delivered to the lungs or is absorbed by the mucosa in the upper respiratory tract or even oral cavity (similar to NRTs). Studies have shown even 16mg and 18mg nicotine liquids fail to increase blood nicotine levels. However, in experienced consumers who were using advanced e-cigarette devices, nicotine levels in blood were elevated; still they were much lower than the levels found after smoking. In fact, scientists believe that nicotine delivery and absorption from e-cigarette should be increased so that they become more effective in smoking abstinence. The WHO official says the exact opposite. Is this because he prefers people to smoke rather than substitute tobacco with the much safer e-cigarettes?

The biggest misinformation of all comes from statements implying that nicotine is a dangerous substance. Nicotine is not the reason for smokers’ adverse health effects. It is not a carcinogen, it does not cause lung disease, it does not promote thrombosis and it has a minor effect on the initiation or propagation of atherosclerosis. Compare this to an almost 3-fold (200%) higher chance of developing cardiac disease in smokers of 1-4 cigarettes per day compared to non-smokers!!

The statement by the WHO official is a “novelty”; it looks like a strategy towards promoting tobacco in order to discredit e-cigarettes. This is a very dangerous path. WHO predicts more than 1 billion deaths due to smoking in the 21st century. I wonder whether their goal is to try to reduce smoking-related disease burden or to just verify their statistics…

Later in the video, the director of Philippines FDA is stating: “Just like any other tobacco product, they (e-cigarettes) have chemicals.” I understand that probably he means “harmful chemicals” (or it was a bad translation). However, a proper statement should be: “Unlike any other tobacco product, the chemicals found in e-cigarette have minimal (if any) toxicity.” That would be a statement supported by scientific facts.

We are reaching a point where several e-cigarette consumers are discouraged from using them. There is a high chance that these people will relapse to smoking (some have already done that). Someone may be held responsible for the adverse effects on their health in the future. Scientists should remember that they have the ethical and legal responsibility to inform the society about the truth and the scientific data available. This should be done without misinterpreting the results and without introducing personal ideology or preference in order to distort the truth.

Note: in every statement I made, a reference is included (links in blue-underlined text). I kindly invite Dr Trinidad to provide his own research and references supporting his statements.

 

Dr Farsalinos is a researcher at Onassis Cardiac Surgery Center in Athens-Greece and at Medical Imaging Research Center, University Hospital Gathuisberg in Leuven-Belgium. He is actively involved in research on e-cigarettes’ safety and risk profile.

 

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