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ENVI workshop on electronic cigarettes (07-May-2013): discussing theory, hiding facts

Before being informed about the participants to the workshop, I thought that this meeting would be a great opportunity to inform the public health authorities about the scientific evidence currently available on electronic cigarettes.

However, when I saw the program and presenters that were invited, I was almost sure that it would be a waste of time. Unfortunately, my prediction was absolutely confirmed, based on the slides of each presentation released. Besides Prof. Etter, who has done some research and could present his findings (real scientific evidence), none of the remaining participants have ever been involved in any research on e-cigarettes. What was really surprising and unexpected, was the amount of misinformation presented in this conference. In fact, some of the presentations were shockingly misinformative; they either avoided reporting scientific data already available or, in few cases, they presented them in a distortive manner.

For start, the representative of the European Respiratory Society said virtually nothing. This is a major improvement compared to last year’s press release of this society concerning e-cigarettes, stating that “In general, ERS subscribes to the medical principle of primum non nocere and holds that Tobacco users should not trade one carcinogenic product for another...”. The difference between that and today’s opinion is striking. Moreover, several of the questions he expressed have already been studied. E-cigarette emissions have been examined by 3 studies, Schripp and coworkers, compared emissions from tobacco and electronic cigarette. They tested 20 chemicals released to the environment. All of them were present in cigarette smoke environment; only 6 were present in e-cigarette vapor environment, at levels 2.5 (acetone) to 50 times (acetaldehyde) LOWER compared to cigarette. Romagna, Farsalinos and coworkers presented at the 2012 congress of Society for Research on Nicotine and Tobacco results of a study comparing passive vaping with passive smoking. They found 10 times less total organic carbon compounds and complete absence of toxic substances like acrolein toluene and polycyclic aromatic hydrocarbons. McAuley and coworkers found “no apparent risk to human health from e-cigarette emissions”. The representative asks for clinical trials and post-marketing studies. We agree with this, and in fact this supports the concept that e-cigarettes should be available to the consumer (otherwise no such studies can be performed). In general, more studies need to be done, but this does not mean that we know nothing.

The presentation of Prof. Pisinger was a big, but unpleasant, surprise. At first, she describes an obvious fact, that we need several more years and many thousands of users in order to determine the long-term consequences of e-cigarette use. Then, some strange statements are made. For example: “Mostly only “traces” of toxins but the inhaled aerosol undergoes changes in the human lung”. This is a statement with no meaning. Changes in the lung (IF they happen) could never increase the amount of these toxins (or we have to reject the relativity theory). She wanted to say something else probably. Then, she presented some really unfortunate picture choices (humor? I couldn’t perceive it-inconsistent nicotine labeling is NOT dangerous by itself, it is already happening in regular cigarettes since authorities still accept the ISO method of defining nicotine content in cigarette smoke) and finally she referred to reports on e-cigarette safety. She mentioned an “Increasing number of adverse events, many with causal relationship”. Data come from FDA, as she mentions, however, the FDA reporthas received 47 reports of adverse events since 2008, with 8 of them being serious (in 4 years-time). Additionally, authors mention: “Of note, there is not necessarily a causal relationship between AEs reported and e-cigarette use, as some AEs could be related to pre-existing conditions or due to other causes not reported.”. Prof. Pisinger supported the exact opposite! Interesting… Finally she supports that smoking cessation is possible and presents a graphic which DOES NOT represent smoking cessation. The difference in % of smokers between 1950 and 2010 is NOT information about smoking cessation but most probably about fewer people initiating smoking. Despite that, does Prof. Pisinger think that a 25% smoking prevalence in the general population is not important and these people should not be offered tobacco harm reduction products?

Prof. Etter made an excellent presentation, but he was just the exception in the hostile environment of the ENVI committee.

Almost everyone invited expressed their concern for the “unknown”, ignoring the variety of data already available about the components of e-cigarette liquid and vapor. Overall, no mention was made on chemical and toxicology studies which have shown that e-cigarettes (irrespective of their quality of production) are BY FAR less harmful compared to tobacco. In Greece only, more than 300 liquids have been tested by independent university laboratories, and none had nitrosamines or polycyclic aromatic hydrocarbons at levels considered to be harmful. Obviously, we have to wait for several years to see the long-term effects; however, the potential of e-cigarettes to successfully neutralize the adverse health effects of smoking is undeniable! And current experience has shown that even if public health officials avoid looking at real evidence, courts and judges do not ignore them.

P.S. I was informed that, with excessive arrogance, some of the speakers tried to discredit the validity of all studies already performed on e-cigarettes. I should mention that it is very common in the scientific community to see someone who failed to be a pioneer in a field of research criticize others who have succeeded. Instead of commenting more and discussing about misinformation, I would suggest that they should begin to realize the major ethical issues behind trying to prohibit the use of a product which has been determined (until now) to be a much safer alternative to smoking

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