E-Cigarette: “But DOC! I am not Smoking I am Vaping”
There is little data on Electronic Cigarettes aka E-Cigs in medical literature. For those not too familiar with the E-Cigarette, it is basically a vaporizer the size of a cigarette. As the FDA described it in their website “Electronic cigarettes are products designed to deliver nicotine or other substances to a user in the form of a vapor. Typically, they are composed of a rechargeable, battery-operated heating element, a replaceable cartridge that may contain nicotine or other chemicals, and an atomizer that, when heated, converts the contents of the cartridge into a vapor” Today I learned from someone that uses an E-Cigarette a new term and that is that the act of using an E-Cigarette is not smoking but VAPING. I got curious about the concept and decided to look in Pubmed for medical literature and this is what I found.
There are limited studies to draw conclusions about Vaping. Question is; Is it reasonable to assume that vaping is better than smoking? I mean, approximately over 4000 chemical compounds are created by burning a cigarette, of these; it is known that many are toxic and/or carcinogenic. In the other hand recent publications have found that e-cigs contain carcinogens such as nitrosamines and diethylene glycol, an ingredient in antifreeze.
In the FDA webpage you can find Concerns that they have about E-Cigarettes;
1.- FDA found significant quality issues that indicate that quality control processes used to manufacture these products are substandard or non-existent.
2.- Cartridges labeled as containing no nicotine contained nicotine and that three different electronic cigarette cartridges with the same label emitted a markedly different amount of nicotine with each puff.
3.- Concerns that the marketing of products such as e-cigarettes can increase nicotine addiction among young people and may lead kids to try other tobacco products.
All very valid points if you ask me, I am particularly concerned about #3.
Recently the FDA issued a letter to the Electronic Cigarette Association inviting electronic cigarette firms to work in cooperation with the agency toward the goal of assuring a lawful marketing approach.
Searching for more information in PUBMED brought the obvious. More studies need to be done in order to say that Vaping is better, equal, or worse than Smoking for several reasons. As mentioned above Vaping has also shown to have carcinogens but nowhere near the 4000 chemical compounds.
So as for what the future holds for vaping it is still uncertain. So as someone who has seen family members and friends being unable to stop smoking after trying all the possible medications out there; chantix, bupropion, nicotine patches, nicotine gum, etc. Would it be wrong or irresponsible of me to tell them to try electronic cigarette instead of a normal one? Vaping is not free of risk but is sure sounds like a good option for those that have tried approved options and have been unsuccessful.
What do you think?
Being new to social media and maybe being extra careful. I will say that until further studies are done, VAPING is not a recommended treatment or option to stop smoking… but it sure sounds better to me than the latter.
This post was done several months ago, but now got revived recently. Wanted to see if I could get different opinions or experiences! Thanks!
Bibliography
http://www.fda.gov/newsevents/publichealthfocus/ucm172906.htm
Am J Prev Med. 2011 Apr;40(4):472-5. Electronic cigarettes as a smoking-cessation: tool results from an online survey. Siegel MB, Tanwar KL, Wood KS.
Addiction. 2011 May 18 [Epub ahead of print]Electronic cigarette: users profile, utilization, satisfaction and perceived efficacy. Etter JF, Bullen C.
Nicotine Tob Res. 2011 May 12. [Epub ahead of print] Interviews With “Vapers”: Implications for Future Research With Electronic Cigarettes. McQueen A, Tower S, Sumner W.
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The FDA only did tests on the Liquid not the vapor that was produced from it.
Vaping is just like being at a concert yet they didn’t add Nicotine to the machine.
Is going to a concert or any play or so that uses a fog machine come with a warning label?
The FDA reports were misleading,they twisted the words around to make E-Cigs sound worse than they are.
Tests HAVE been done and shown that E-Cigs are no more harmful than current Nicotine Relacement Therepy,in fact 80% of the people that try NRT’s go back to smoking cigarettes while 90% of people that try E-Cigs quit smoking period.
Massive,and I mean MASSIVE money would be lost if people quit smoking cigarettes and went to E-Cigs,do you think all the organizations that are funded by Pharma Companies and anyone else who gains from Cigarettes is going to let this happen?
I totally agree with the above comment. I quit smoking cigarettes after 20 years on New Years 2012, and haven’t had a puff on a cigarette since. And I’ve tried everything on god’s green earth to quit, and never could. Big Tobacco is behind this, and it’s just proof that politicans are -again – going to stick their nose into our business through having their pockets lined by Big Tobacco lobbyists-ban cigarettes that contain thousands of carcinogens-and leave vaping to those of us who want to inhale flavored water. I carry around a stylish, slim vape tube now-instead of a cancer stick, that would within time have me carrying around an oxygen tank!
Do not get me wrong. The reason why I wrote the blog is because I support them. Problem was every time I wanted to prescribe it I got issues from the hospital clinic regarding FDA approval… Which is frustrating… In my opinion there is no way on earth that a e-cig would be worse than a normal cigarrette.
So X-Smoker! Congrats!! Good for you on quitting smoking and keep up the good work!!!
TY Medbonsai. I had to find this on my own, and wish a doctor had helped me in the past 🙂
Too much old information is reproduced in this article; plus the suggestion that there is little material regarding e-cigarettes in the literature is just wrong. At the last count there were over 50 tests, clinical trials and surveys.
Nobody has ever produced any kind of *evidence* that e-cigarettes have potential for harm. First, the harmful agent (ingredient) would need to be identified, then the mechanism for morbidity would need explanation. None of that has happened. Instead, we are repeatedly reminded of the FDA’s press release, which bore little relation to the lab results.
Read the lab report. Carcinogens are certainly present – at the same levels as those in nicotine skin patches. A professor of medicine who is an expert on these matters has stated: “These levels are millions of times lower than is significant for health”.
DEG (anti-freeze) was detected at minutely low levels in one liquid sample out of 18, but was not detected in the vapor. Please read the report, not some spin doctor’s PR version of it.
Please ask yourself: why have several professors of medicine who are public health experts backed e-cigarettes strongly in public? Why have doctors’ associations backed e-cigs? (AAPHP, ACSH). Why do heads of public health departments endorse e-cigarettes?
Answer: because there is absolutely no evidence they can cause harm. We are talking about the lab reports and clinical trials here – not some paid-for propaganda published by the pharma industry’s astroturf lackeys. If you believe that the National Enquirer (US) or Sunday Sport (UK) are genuine examples of scientific evidence and fact, then by all means believe the propaganda. Personally I don’t think it’s likely my e-cig will kill me or that I’ll be abducted by aliens for intrusive medical tests.
But you are welcome to believe this sort of material if you want.
Thank you very much for your comment. Do not get me wrong, I do believe that e-cigs are better. If it was I who smoked I would be more than willing to try this. This is the reason for me writing this post couple of months ago.
Now something is consistent in the further research I did and that is that the amount of nicotine which the patients or “e-smoker” obtains from puffs is difficult to quantify and thus difficult to give the appropriate dosage.
Another problem arises when I am recommending them and if they are FDA approved. Which to my knowledge they are not.
I know patients who use them and have decreased the amount they smoke. That to me alone is a success, but as usual politics play an important role.
Thanks again for commenting! Appreciate your input and if there are links you want to share with the rest of us please go ahead.
Medbonsai, the gram of tobacco in an average commercial cigarette contains about 1.63% nicotine but the majority of this destroyed by combustion (converted to sticky brown particles of “tar”) and based on increases in blood cotinine levels, most smokers absorb about 1mg of nicotine per cigarette smoked–regardless of the actual nicotine content of the cigarette.
The pharmaceutical grade nicotine used in smokefreE-cigarettes, however, can only be absorbed through skin and soft tissue in the mouth and upper respiratory system which is a slower mechanism than if delivered in freebase form in cigarette smoke inhaled deep into the lungs. This means that a new e-cig user MIGHT choose to use more nicotine than they were getting from cigarettes, but since the body’s response to nicotine is to hiccough or vomit if swallowed severe or fatal outcomes of nicotine poisoning are extremely unlikely unless combined with an anti-emetic or something like the pharmaceutical patch where vomiting does not stop the device from continuing to provide nicotine beyond what the body can safely metabolize. E-cigarette users should of course, closely monitor, their nicotine intake…but since most people don’t like to vomit, stopping nicotine use when you’ve had enough to satisfy the desire to smoke comes pretty naturally. 😉
Thank you very much for your comment. Do not get me wrong, I do believe that e-cigs are better. If it was I who smoked I would be more than willing to try this. This is the reason for me writing this post couple of months ago.
Now something is consistent in the further research I did and that is that the amount of nicotine which the patients or “e-smoker” obtains from puffs is difficult to quantify and thus difficult to give the appropriate dosage.
Another problem arises when I am recommending them and if they are FDA approved. Which to my knowledge they are not.
I know patients who use them and have decreased the amount they smoke. That to me alone is a success, but as usual politics play an important role.
Thanks again for commenting, appreciate your input and if there are links you want to share with the rest of us please go ahead.
Cahn Z, Siegel M. Electronic cigarettes as a harm reduction strategy for tobacco control: A step forward or a repeat of past mistakes? Journal of Public Health Policy advance online publication 9 December 2010; doi: 10.1057/jphp.2010.41. http://www.hsph.harvard.edu/centers-institutes/population-development/files/article.jphp.pdf
Miura K, Kikukawa Y, Nakao T, Tokai H, Izumi Y, Fujii H, Hojo, T. Safety Assessment of Electronic Cigarettes in Smokers. SEIKATSU EISEI (Journal of Urban Living and Health Association). Vol. 55 (2011) , No. 1 p.59-64. http://www.jstage.jst.go.jp/article/seikatsueisei/55/1/55_59/_article
R Polosa, P Caponnetto, J B Morjaria, G Papale, D Campagna, C Russo: Effect of an Electronic Nicotine Delivery Device (e-Cigarette) on Smoking Reduction and Cessation: A Prospective 6-Month Pilot Study. BMC Public Health 2011, 11:786. http://www.biomedcentral.com/content/pdf/1471-2458-11-786.pdf
Rodu B. The scientific foundation for tobacco harm reduction, 2006-2011. Harm Reduct J. 2011 Jul 29;8:19. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161854/?tool=pubmed
Laugesen M. Safety Report on the Ruyan® e-cigarette Cartridge and Inhaled Aerosol. 10- 30-2008. Christchurch, New Zealand, Health New Zealand Ltd. Ref Type: Report. http://www.healthnz.co.nz/RuyanCartridgeReport30-Oct-08.pdf (accessed June 2011)
Laugesen M. Second Safety Report on the Ruyan® e-cigarette Cartridge and Inhaled Aerosol. 9 Apr 2008. Christchurch, New Zealand, Health New Zealand Ltd. Ref Type: Report. http://www.healthnz.co.nz/2ndSafetyReport_9Apr08.pdf (accessed June 2011)
Laugesen M. Comparison of vapor components to cigarette smoke toxicants. http://www.healthnz.co.nz/ECigsExhaledSmoke.htm (accessed June 2011)
Laugesen M. Ruyan® E-cigarette Bench-top tests. Poster 5-11, Society for Research on Nicotine and Tobacco (SRNT) Dublin, April 30, 2009. http://www.healthnz.co.nz/DublinEcigBenchtopHandout.pdf (accessed June 2011)
Ben Thomas Group, LLC. Study to Determine Presence of TSNAs in NJOY Vapor. December 9, 2009. Report. http://www.casaa.org/files/Study_TSNAs_in_NJOY_Vapor.pdf (accessed June 2011)
Finally, I give you the link to the the most important (and the most ignored) document on the FDA web site regarding their tests in 2009: The report issued by B.J. Westenberger, the toxicologist who supervised the testing: http://www.fda.gov/downloads/Drugs/ScienceResearch/UCM173250.pdf
I refer you to the results of the tests on simulated use (i.e. the vapor, rather than the liquid). See the last sentence on page 4 and continue reading the rest of the paragraph on page 5.
You will find a lot of deception in the FDA’s summary statement:
“One high-nicotine cartridge delivered twice as much nicotine to users when the vapor from that electronic cigarette brand was inhaled than was delivered by a sample of the nicotine inhalation product (used as a control) approved by FDA for use as a smoking cessation aid.”
Wow! Doesn’t that make it sound as if users are about to drop dead from nicotine poisoning if they inhale vapor? But when you learn the rest of the story, that vapor delivers, at most, half the amount of nicotine per puff than a puff of smoke, then you begin to understand why the “nicotine inhalation product” has been so ineffective: It delvers inadequate levels of nicotine to function as an acceptable substitute for smoking.
When our hospital clinic complains that e-cigarettes are not “FDA approved” they are confusing e-cigarettes with treatments for nicotine dependence. The purpose of e-cigarettes is to function as a permanent reduced-risk replacement for inhaling deadly smoke. If you discovered that chewing on a toothpick helped some folks quit, would the hospital clinic complain that toothpicks are not FDA-approved?
Thank you so much for showing me this. Greatly apprecianted. I hope it will help other doctors and patients!
The only people claiming this drug addiction is safe are the ecigger addicts who like any other addictions meth, coke,heroin, nicotine look for any little meaningless bits of information on why their drug addiction is safe.
The only acceptable safety standard for a non-essential recreational drug with potential to harm bystanders is conclusive proof by independent research that passive exposure to e-cigarette vapour is “as safe as or safer than not being exposed to it at all.” NOT some junk posted by casa(Consumer Addicts Should Advocate Addiction) who profit from your addiction and would like to addict your family and children to this dangerous addiction
And e-cigarette proponents alone bear the entire burden of proving their product safe for use around others by this standard. The public does not owe it to them.
Wowa. Hello there. I guess I understand your frustration but lets be a little simpathetic to the smokers. Yes I agree if you are not a smoker it is not a pleasant smell but they are trying. Many smokers who want to quit find it very frustrating when they are unsuccesful and are just trying for different options.
Now, if you think that a non smoker inhaling vapor could be detrimental to his health (which has not been proven) what do you think of the air in the streets? Cars, motorcycles, airplanes, factories, soaps, gasoline, other chemicals… Its an assumption but that sounds worse.
I think its a little drastic comparin e-cigs to meth, cocaine, and heroin.. Remember e-cigs can also be nicotine free and all they would be doing is inhaling vapor. In brief, its just like a vaporizer we used when we got sick as children.
just saying, thanks for your comment
Sorry you were exposed to Electricman, Dr. He is a troll who follows e-cig users around with tripe like this. We’ve learned to ignore him.
Thank you for standing up for us and for smokers–very few do. Politics-wise, we’re fighting the same battles.
I choose to vape rather than smoke, but my personal decision and my advice to a pt are often different; as in other facets of my personal life. I realize the research/verdict is still out, and although I feel strongly that I made the right choice, I’m not going to insist that I’m right – yet. I have come to admire the intelligent and non-combative stance of the vaping world rather than an “in your face” approach. I suspect that mutual respect, responsibility and research will take this much further than waging a war.
@Medbonsa – I just want to thank you for your sympathy to those who smoke. I has long become the practice of a majority of non-smokers to consider smokers as “second rate citizens” meaning that they look down their noses at us. I have not had a traditional cigarette in almost 2 years thanks to the electronic cigarette. It is important that the public have all the info on these products, the good AND THE BAD. If there is any bad point to electronic cigarettes I think people should know it. For 1 I think people should realize that nicotine in and of itself is not good for you. In small doses it has proven to increase brain function and has even been tested to treat Alzheimer’s disease. But we know in the higher does that us smokers usually like, they are not good for heart health. So life is a trade off. I guess what I am saying is everything we do in life can have risk, heck driving a car is not really safe but most of us do it everyday. So thank you for your comments and your report. I just hope the government can stay out of our way so we can continue to choose our OWN path whether it be right or wrong.
Hello Eric. In my opinion one of the most important qualities of a doctor should be sympathy towards others. One has to be able to put themselves in the shoes of others and see, evaluate the situation from the other’s eyes. Old habits die hard, as bad as they can be. I can understand how non-smokers can be displeased about people who smoke around them but to avoid conflicts in future posts I will avoid commenting if this ir right or wrong. This would lead to a pointless debate…
Good for you on making the switch to a electronic cigarette! Its been 2 years and maybe its time to try the E-Cig without nicotine? It is obvious that more information is needed to determine if E-Cigs cause any harm or are related to any cancer but by assuming and comparing them to the normal one, it sure seems like a better choice.
The way I see it you made a good choice and 2 yrs with E-Cig is great. Its by comments like yours that I can use with my patients, and tell them different experiences. I’ve had patients that have tried everything Chantix, Nicotine Substitutes even anti depressants and nothing works, but E-Cig has helped them at least make a jump and give hope.
So Congrats to you my friend! Now the next question comes. Can you drop the E-Cig? Maybe the lack of information regarding consequences of longterm e-cig smoking doesnt give you a reason to do so, but with the information you have given me… I know you can do it if you find the reason to do so… but thats not for me to tell you but for you think about.
Best of Luck and thanks for your comment!
In October 2010, the FDA held a two-day workshop on Risks and Benefits of Long-term Use of NRTs. Since there are no controlled experiments on long-term use of NRTs, nicotine expert Dr. Neal Benowitz presented data on health risks associated with snus, a low-nitrosamine moist snuff product used extensively in Sweden. Relative risks of MI range from 1.06 to 1.13 and for stroke range from 1.4 to 1.42. These risks are relative to never-users of tobacco. (Relative risks hover around 1.0 for snus users compared with former smokers who gave up all sources of nicotine.) He stated “Meta-analyses showing increased risk of MI and stroke in ST users are heavily weighted by CPS-I and CPS-II, which are older US studies with many methodologic problems. More recent Swedish studies and an NHANES study indicate minimal if any increased risk of CVD with ST.” http://www.fda.gov/downloads/Drugs/NewsEvents/UCM232147.pdf So the risks of heart disease with use of a non-smoked source of nicotine are not as high as was previously thought. My doctor asked me if I was still using an e-cigarette. Yes, I told him, for the 3 years I have been smoke-free. He then asked when I planned to give up using an e-cigarette. I told him that I’d consider it once I no longer had any need to be able to pay attention, concentrate, and remember things. His jaw dropped. Since I have a great deal of trouble functioning without those skills, I don’t plan to quit nicotine any time in the near future. My mother lived to be 88 without any heart problems. But I did watch her slowly and painfully lose her mobility, cognitive skills, and sanity over the course of her last 20 years. Research shows that nicotine interrupts the deposits of alpha-synuclean proteins in the brain, thought to be the cause of Parkinson’s and Lewy Body Dementia (my mother’s Dx.) Frankly, I would prefer dying of a nice-quick case of heart failure than to suffer what she went through and to put my family through watching that suffering.
Hello Elaine. I understand your point of view and respect them. Now couple of things.
1) SNUS/SNUF maybe associated with less cardiovascular disease, or maybe an equal incidence of cardiovascular problems… But that does not mean that it is safe, the incidence of Oral cancer is far higher in individuals who use snuf or snus. Sweden has one of the highest incidences of oral cancer and that is because of its common use of this.
2) Attention, concentration are without a doubt affected by nicotine and going cold turkey will likely give you a lot of problems, that is why this has to be done slowly. Maybe you have tried this and it has not worked and its possible. No one said it was easy. Its like getting in an exercise routine. Depending on your goals it can be a pain, and require a lot of discipline to achieve your goals, but sooner or later, after several attempts you start getting a hang of it.
3) I understand the concept of Nicotine helping with brain synapsis but smoking or vaping will not decrease the incidence of such, or at least it has not been proven… BUT SMOKING is associated with a higher incidence of Dementia. “Middle-aged smokers are far more likely than nonsmokers to develop dementia later in life, and heavy smokers — those who go through more than two packs a day — are at more than double the risk, a new study reports” this was published in Archives of Internal Medicine. THis is the link to the NYT
4) You said “would prefer dying of a nice-quick case of heart failure than to suffer what she went through and to put my family through watching that suffering”
– CHF is not quick and is not nice, it can lead to kidney failure, liver failure, and multiorgan failure.
– You probably mean a heart attack and myocardial infarction which that instead of killign you can leave you with a severely impaired heart function and your quality of life could be severely affected depending on the degree of the damage.
I have colleagues that smoke and when I ask them why they do it they say “Because it makes me feel good”. I do not argue with this. Me personally I am a healthnut. I am extremeley active. I like exercising and watching how I get fitter as time goes by. Im 33 years old now and probably in better shape than I was at 18. That is what makes me feel good and will keep striving to be better as time goes by. An example for me to follow is Tony Horton, the creator of the P90X routine.
Anyways, I wish you the best. Thanks for your comments
Over the years that I smoked and made quitting attempts, I started to notice that each time I tried to quit, I got sick. I finally began to wonder whether this was really a coincidence, so I began trying to find some answers. After a lot of research, I lined up my ducks. I went to my doctor and procured a prescription for the patch. I enrolled in (and subsequently attended all sessions of) the American Lung Assn’s 6-week Freedom from Smoking class. Despite the fact that my doctor allowed me to go an additional 2 weeks on the 7 mg. patch (after having completed the FDA-approved schedule of stepping down from the 21 mg patch to 14 mg) I continued having difficulties. Two weeks after taking off the last of the 7 mg patches I was curled up in a fetal position on my couch, trying to figure out what might be the least painful way of killing myself. I was in mental and physical agony, as I had developed a severe case of bruxism during my sleep. Speaking of which, I couldn’t seem to keep my eyes open. I was sleeping about 12 hours a day, in fits and starts, and began gaining weight at the rate of about 5 pounds a week. When awake, I felt as if I was in a fog–literally. I could see black clouds closing in from the side. Nevertheless, I was determined to quit. In those days, you had to have symptoms of depression for at least 2 weeks before they would prescribe medication. The first one they put me on worsened two of my symptoms. I began sleeping 16 hours a day, and when awake, I craved carbohydrates. My heart seemed to be racing, and when I took my pulse, it was 120. Two weeks later, having gained an extra 10 pounds a week, I went back and demanded a change in medication. I was told I had to stay on the med for 6 weeks to determine whether it would work. I went home and collapsed in tears. Then I got angry, called back and demanded an emergency appointment for the next day with a different doctor. She did something the first doctor didn’t do: she took my pulse. She agreed that amitriptyline was probably not the best fit for my symptoms. She switched me to fluoxetine, and my symptoms of depression started to clear up. The weight gain stopped, but despite starting a diet and taking up daily walking and bike-riding. I was unable to lose the extra 30 pounds that I had already gained, Fortunately the bruxism cleared up spontaneously after about 3 to 4 weeks. Unfortunately, the confusion and forgetfulness persisted.
I was really determined to quit, though, and I waited for six months for these problems to resolve. When they did not resolve, I went back to the doctor and asked for some medication that would give me back the ability to read, remember, write coherently, and drive a car safely. She shook her head sadly and told me that there was nothing she could prescribe. She said that there was research showing that nicotine improves memory and concentration, and even creative abilities. At that point, I was fearful of losing my job. I had been coasting along writing about one-tenth of my former output and my boss was beginning to drop hints about my poor performance. I made a conscious decision to go back to smoking. So much for Plan A, doing a gradual reduction in nicotine and treating symptoms as they arose. There were no treatments for some of my symptoms.
So Plan B became a waiting game. I figured that some day there would be alternative sources of nicotine that would keep my symptoms controlled without exposing my lungs to the devastating effects of inhaling smoke. When patches became available OTC, I tried substituting them, but developed a nasty skin reaction to the adhesive. When 2 mg nicotine gum became available OTC, I found that it didn’t do much at all to keep my symptoms controlled. It also tasted like a used ashtray. When 4 mg gum became available OTC and came in some more palatable flavors, I was able to substitute 5 pieces of gum a day for all except 10 cigarettes. When I tried to chew more, my stomach rebelled. I also burped a lot, which, for a lady, is embarrassing. I kept watching and waiting for something like the e-cigarette to come along. You know the rest of the story. Smoke-free for 3 years.
BTW, nicotine did not cause my mother’s brain deterioration. She never smoked a day in her life nor use any form of tobacco whatsoever. A company called Targacept is conducting clinical trials on a drug for dementia derived from nicotine.
I don’t claim that snus use is totally harmless, but the reports of increased risk of oral cancers may be overblown. Switching to snus without a doubt reduces risk of all types of cancer compared with continuing to smoke. I do not recommend that any non-tobacco user take up snus or e-cigarettes. However, millions of lives of smokers who can’t quit could be saved by promoting switching to a less-hazardous alternative.
Dr. Benowitz’s presentation (previously cited) stated that there is “No evidence that nicotine causes or promotes cancer.”
http://www.ncbi.nlm.nih.gov/pubmed/18412245
In 2008, the Karolinska Institutet reported an increase in the incidence of the combined category of oral and pharyngeal cancer among daily users of snus; however, they found only a 1.1 hazard ratio for overall mortality in snus users. Also keep in mind that their comparisons are for snus users versus non-tobacco users, not versus smokers.
http://www.ncbi.nlm.nih.gov/pubmed/21163315
Subsequently, a meta-analysis by Lee found “After smoking adjustment, snus is unassociated with cancer of the oropharynx (meta-analysis RR 0.97, 95% CI 0.68-1.37), oesophagus (1.10, 0.92-1.33), stomach (0.98, 0.82-1.17), pancreas (1.20, 0.66-2.20), lung (0.71, 0.66-0.76) or other sites, or with heart disease (1.01, 0.91-1.12) or stroke (1.05, 0.95-1.15). No clear associations are evident in never smokers, any possible risk from snus being much less than from smoking. “Snuff-dipper’s lesion” does not predict oral cancer.”
http://www.ncbi.nlm.nih.gov/pubmed/21617206
In 2011, Swedish researchers reported on the direct effects of pure nicotine at the cellular level. “The combination of alterated gene expressions and strongly inhibited DNA synthesis was only detected in cells exposed to smoke extract. In the presence and absence of ethanol, pure nicotine and Snus extract induced abnormalities in the cytoplasm without any significant degree of cell death. With similar doses of nicotine and ethanol, the additional components in smoke extract had a dominant effect. The smoke extract induced vast cellular abnormalities and massive cell death.”
Our Gov’t politicians are on the take getting kickbacks to Ban vaping, e kickbacks are coming form Big Tobacco and Big Pharma. The amount of money lost on Taxes alone would hurt the Gov’t budgets, the monies lost on cancer research and cancer treatment alone from all the people who quit smoking would hurt Big Pharma, the Dr’, hospitals and that whole industry of medical research and treatment. Let’s face it our Govt doesn’t want vaping because of the loss’s all these other industries would take, therefore all these other industries are sending there lobbyist to pay off Govt officials, its really a shame these Gov’t official;ls are supposed to be representing us the people of the United States, I’ve lost all respect for any Gov’t official that is against vaping because he is either totally uneducated about it or on the take receiving kickbacks of cash
Hello Mathew. I was not aware that there was a plan of banning vaping. Maybe its a rumor? If you have any information or resource where this information can be found please share.
Now, regarding government… I would rather not get into a political discussion and I leave your post for other to read and discuss with you.
Thank you for your comments
Please check out http://www.e-cigarette-forum.com/forum/
It’s a mammoth noncommercial forum that started about 3 years ago, with many subforums covering a broad array of ecig related topics, and you can learn absolutely everything that you’d want to know about e-cigarettes. There’s a great deal more than most people think. A very supportive, fun and diverse community.
I (astonishingly, and easily, after trying everything else) quit a 3 pack a day, decades-old smoking habit over two years ago with ecigs and have never looked back. It’s wonderful. I feel terrific. Check it out!
After smoking 2 packs of tobacco cigarettes a day for over 45 years I discovered that I had Type 2 diabetes. I then had congestive heart failure and had to have open-heart surgery. Of course (left with 1/3 of my heart) I quit smoking. Despite patches, nicotine gum and lozenges, I never seemed to make up for the loss of my very favorite (albeit unhealthy) habit. After years of frustration with the likes of nicotine patches, gum and finally lozenges (I was up to 8-9 – 4mg lozenges – 32-36mg per day) and still unsatisfied and unhappy… I heard about e-cigarettes.
After using an e-cig a couple of months, friends and associates began to mention to me that I “looked better” and had “better color” and didn’t have the “stink of tobacco”. My wife, who never smoked a single cigarette, was overjoyed as I was, but for different reasons. She no longer had to put up with the stench in the house, car, and clothing (plus second-hand smoke). No more cleaning up ashes, dealing with frustrating furniture and carpet burns. But, most important to her was that I was no longer hacking, coughing and not breathing well, my incessant griping about not being able to smoke had ceased… plus, my general happiness levels were through the roof. I have not smoked a single tobacco cigarette since I began vaping a year ago nor do I have the slightest desire to resume the habit.
Please understand that using a personal vaporizer instead of smoking tobacco is really for those who do not choose to “give up” or “quit” smoking. Rather it is for those who truly enjoy smoking, but do not wish to constantly subject their body (and others) to the extensive list of harmful ingredients sustained in a tobacco cigarette smoking habit.
Aside from the toxic chemical issues there are other factors to consider: Costs for e-cigarette use is less than half the cost of tobacco smoking (this includes no exorbitant taxes and costs for damage to clothing, furniture, carpet, interiors, etc.). The stench of smoking tobacco, “yellow” teeth, messy butts/ashes and the stigma of second-hand tobacco smoke has been eliminated.
Let’s be honest, with my diabetes (type II) and with only a third of my heart left, I vape constantly while awake and I have suffered no ill effects whatsoever. Coughing is nonesistant and I move around a LOT better without the stinky mess that my tobacco cigarettes left me with. Yeah! These e-cigs are pretty terrible for my health… NOT!
The real controversy in the US is over the e-juice not the actual e-cigarette devices. Even the government admits the actual devices contain no harmful components, but the e-liquid (with or without nicotine) that is required to make the e-cig work is uncontrolled. This is where the government will probably make a regulatory move in the future. Admittedly, standards for e-liquid manufacture should be set for the safety of all users. This would provide a benefit to all e-cigarette vapers, but formally doing so will open the door to additional regulations (and more taxes to enforce them). E-liquid will then escalate to the point of present tobacco cigarette costs in order to replace the loss in tobacco cigarette tax revenue.
It should be noted that, if current self-regulating e-juice manufacturers both in the US and abroad were selling harmful products, there would have been an uproar and extensive news reports of this. In the many years that e-cigarettes have been available, this has never occurred.
ITS REALLY ALL ABOUT THE MONEY!
The bottom line is that, regardless of any possible health benefits due to harm reduction, Federal, State and local governments do not want e-cigarettes sold in the USA. This is because people switching to e-cig use eliminates a significant tax base which all our various governments exploit to function. Also, big tobacco and especially pharmaceutical companies do not want their business curtailed even slightly by e-cigarette use. The combination of the above have massive money and power and will do just about anything to protect their sources of income. Of course you know that our government and large corporations would never lie to the American public to make money 🙂
VAPE ON!
Hello Douglas
Ill stay away from the Political controversy as usual, 😉
But I do want to mention something thought about a comment you said which is:
“personal vaporizer instead of smoking tobacco is really for those who do not choose to “give up” or “quit” smoking. Rather it is for those who truly enjoy smoking”
This depends on the individual. I have witnessed several patients make a jump to vaping and then were able to quit vaping thus stopping smoking completely. This was after failed attempts with chantix, andtidepressants, and other NRS.
But good for you, vaping sounds better than the 2 packs a day!
Thanks for sharing
Thanks for your response. I started with 24mg and went down to 11mg of nicotine in less than a month. Of course you are right about depending on the individual, but I one of those folks who really loves to smoke. Even if I should later go to 0mg of nicotine, I’ll still puff away. What’s wrong with me?
Many ask the same question and the answer usually is the psychological aspect of having something in your hand. Even if you go to 0mg of nicotine youll probably still want to have the e-cig in your hand. If that happens… Maybe just vaping regular H20 will calm your nerves instead of the liquid.. That should be cheaper 😉
Youll likely get to 0mg, tell me how that goes when you get there
Thanks!
MedBonsai- Thank you so much for the thoughtful write up on electronic cigarettes and the open and receptive dialogue you’ve kept up in the comments section. This has been a very informative discussion.
I picked up an electronic cigarette almost 6 months ago and I haven’t had a real cigarette since. I’d been smoking since my teens, and just turned 40 this month. I’d tried the patches, the gum, and Wellbutrin, but was not able to successfully quit for more than a few days with any of those methods. When I started ‘vaping’ I was using 24 mg/ml liquid, but have since gradually reduced that to 12 mg/ml. Before finding electronic cigarettes I was resigned to being a smoker for the rest of my life. I picked one up basically just to try it, in the hopes that I could maybe cut back a little. To my surprise, I ended up accidentally quitting, much like some of the subjects in Dr. Polosa’s study cited above.
Having a degree in a health related industry, I’ve read all that I could get my hands on, trying to have an open mind to both the risks and benefits of electronic cigarettes. I know that I definitely have a bias, because I really want these to be safer than real cigarettes, but I also had that nagging fear after trying almost every other NRT and stop smoking drug (except Chantix, because my Dr. prescribed it so reluctantly) that it was too good to be true. I read the FDA report with what I hope was an open mind, willing to change my opinion if the data warranted, but I perceived a large amount of ‘spin’ in that report. It seems clear to me as a researcher and scientist, that they twisted their results as a scare tactic, and while there were some valid concerns about quality control of Chinese liquids illuminated in that report, it’s also clear that when you look at the numbers they got for nitrosamines, electronic cigarettes are on par with other NRTs on the market and orders of magnitude safer than cigarettes. Their failure to make this comparison in their report speaks volumes to the fact that they already had a conclusion, and had to twist their interpretation to fit their results.
If it was just as easy as quitting, believe me, I would have done that. I’ve tried many times, with the best of intentions. I would love to see further research on electronic cigarettes, and if there are quality control or safety concerns I’d like to see those addressed and corrected rather than used as an excuse to eliminate/over-regulate what I feel is one of the most important harm reduction advances in our current times.
Hello Spaz
Your scenario is exactly the reason why I made this blog. I have had many patients trying to quit smoking and they are unsuccessful. I try prescribing antidepressants, NRTs, chantix, anything that has been available. From my experience support from your doctor, family and friends is key but usually not enough.
Most of my patients tell me that the reason why vaping helps them is due to the fact that they are holding something in their hand. It is a psychological aspect. “Like a Tic” they tell me. Whatever the reason this has helped them drop the smoking and start vaping. Yes we do not know the potential risks of vaping in the long run but we do know the devastating ones from smoking and sounds like a reasonable tradeoff.
One of the problems as you mention is the amount of nicotine that you get from a determined liquid or puff etc, but you are going down nevertheless. Who knows maybe you are getting less nicotine than you thought and now you are just inhaling vapor? 😉
Anyways keep up the good work and keep in touch when you reduce the dose and share with other “Vapers”
Thanks for sharing!
“One of the problems as you mention is the amount of nicotine that you get from a determined liquid or puff etc, but you are going down nevertheless. Who knows maybe you are getting less nicotine than you thought and now you are just inhaling vapor? ”
I don’t see it as a problem really. It’s true that I don’t know how much nicotine I am getting, but I didn’t know how much nicotine I was getting from a cigarette either. I can definitely tell when I’ve had too much, and I suspect that most smokers are pretty good at self regulating nicotine intake from cigarettes, even without knowledge of how much they are getting (a reason the ‘light’ cigarettes didn’t work out so well for harm reduction).
It would be interesting to have some blood work done to see what my cotinine levels are, but I don’t think I really need to know for it to work. As long as I continue cutting back on the levels I will be reasonably sure I am lowering my nicotine usage.
One other benefit that I didn’t mention above, is that I was spending a ton of money on nicotine gum. It wasn’t helping me to quit (I still smoked) but it probably did help me smoke less than I would have otherwise. I used it mostly as something to tide me over when it was socially unacceptable or inconvenient to smoke. I was probably spending $50/month on gum, and I don’t use any now. So on top of the money saved on cigarettes, I am also saving on nicotine gum as well. Just thought I’d add that.
With problem I meant with not quantifying the amount of nicotine tha tyou are getting exactly is that maybe you are not getting anything anymore ;)… Maybe you have been Nicotine free and you just do not know it who knows. O rmaybe you are getting less than expected and the only thing that you have now is the psychological aspect of having something in your hand..
Who knows maybe the next think youll have is a carrot and not an E-Cig hehe
Later!
Oh I see what you mean. Maybe I can set up a double blind experiment by having my husband randomize some liquids for me and see what happens. If I commit any acts of violence when I’m using the 0 nic then we’ll know. LOL!
Oh, I see what you mean. Maybe I can figure out a way to do a blind experiment. I’ll mix up some liquids at 12 and 0 mg, and have my husband randomize them for me. Then, he and I can correlate the days where I commit random acts of violence and aggression with my nic level. LOL!
You may be right. I do feel like I’m still getting some nic though, although I can go longer and longer times without using my PV. I don’t get all craving and antsy for a smoke after hours without it or in stressful situations, like I used to with cigarettes.
Hello Spaz. I just wanted to say that I have used an e-cig for almost 2 years now and I can tell you what I believe is the reason you can now put down that e-cig for longer periods than the traditional cigs. I am no expert, but I know for a fact I do not get the “RUSH” from my ecigs that I got from my cigarettes. I think that makes a big difference in the addiction. When I smoked, I got “instant gratification” as soon as I took the first puff. In other words, the 4000+ chemicals in the cigarette were doing there job in getting that nicotine to my brain as fast as possible. Because all of those extra “nicotine enhancing” chemicals are not present in an electronic cigarette, it is a more gradual feeling of satisfaction. This may explain why you are not jonesing (probably not spelled right) for another puff of that ecig right away!
I could be completely full of crap of course. This is just how I have felt about it.
Thanks for your reply Eric, this is exactly the reason I created this post. It is very helpful for users to share their experiences with each other.
Thanks!
Regarding the 3 points cited in this article:
1. Although the FDA did mention some potential quality control issues, there is no indication that e-cigarettes do not meet any standards–the FDA has just not set any: In the FDA’s preliminary research on e-cigarettes, they found levels of tobacco related impurities that were comparable (nearly identical, actually) to FDA Approved NRTs and other products. Could the industry be improved by quality control standards? Of course….but that doesn’t mean any study to date has cited any method by which a battery powered “fog machine” could cause any serious harm to users or bystanders.
2. This is the closest thing to a real concern: Because the de facto standard has been to refer to nicotine strength in terms of milligrams per milliliter (which frequently gets abbreviated to just “mg”) rather than using percentage, there has been a lot of confusion surrounding this. Not every cartridge contains the exact same amount of liquid and the test is probably not extracting all of the liquid from the cartridge. However, it should be pointed out that a “High” strength 16mg/ml cartridge, actually contains about the same amount of nicotine as a commercial cigarette: 1.63%. The difference is that in a cigarette, most of the nicotine is burnt into “tar” and/or lost to sidestream smoke, so the user only absorbs about 1mg….while, because an e-cigarette is not lit on fire and produces no smoke, one cartridge can be used to replace 10 or more cigarettes.
3. Although it is reasonable to have “concerns” about this issue, a bit of logic and common sense shows that is as far as it can go. First of all, there is no indication that youth and/or non-smokers have any interest in e-cigarettes. Most people start smoking because they KNOW it is unhealthy and they want to be “cool” and rebellious like that. Most non-smokers (and many smokers) think e-cigs look kind of silly. Second, if a non-smoker DID become interested in e-cigs, there is no reason for someone who is not already addicted to nicotine to begin using nicotine in e-cigs. Third, if a non-smoker bucked logic and started using e-cigs AND decided to use nicotine, there is no reason to suspect that this would “increase addiction”–nicotine, without the habit reinforcing MAOI properties of the other alkaloids and byproducts of combustion, is not particularly habit forming (if it was, Big Pharma would never have been able to get FDA approval for their products that use the same type of nicotine derived from tobacco). Finally, if somehow a non-smoker DID decide to try e-cigs, AND chose to use nicotine, and inexplicably became addicted to nicotine–there is STILL no reason whatsoever that this person would suddenly abandon their favorite flavor e-cigarette and get a craving for the taste of burnt leaves! E-cigarettes are a gateway AWAY from smoking: I didn’t even really plan or expect to quit smoking, but after my daughter said, “Daddy, isn’t that pretend cigarette supposed to be better for you? You should use that instead.” I decided to try to use the e-cig as much as possible….within just a few days, my senses of taste and smell improved and I found that I didn’t really like the taste, and I really liked the other health improvements I was experiencing since I was no longer lighting tobacco on FIRE and inhaling the SMOKE 100’s of times a day.
Could e-cigs be dangerous? Nothing in this world is 100% safe, and there are always “unknown unknowns” to consider. However, ALL indications are that e-cigarettes are AT LEAST 99% safer than smoking. Exactly what deaths or serious diseases or long term risks could there possibly be from something that is basically a battery powered fog machine using less than a teaspoon/day of a proven safe and effective air sanitizer (propylene glycol)–even if it contains a small percentage (<5%) of nicotine?
Thanks for your input and comments, other users will find them helpful
Medbonsai, I just wanted to thank you for your support. It is not often that smokers encounter doctors who are understanding as you are. Your blog has inspired me to try and quit smoking one more time. As you have mentioned I am one of those patients who has tried buproprion, chantix, NRS without luck. I know you are no implicitly recommending to start vaping but having read the comments from other users… What can I say it is worth a shot.
Thank you all for sharing your experiences with the rest of the word and thank you once again Medbonsai for making this possible.
Sincerely
Ashley Cooper
Ashley it is a pleasure. Comments like this motivate me to keep doing this types of Blogs. I wish you the best of luck to quit smoking. I know it is difficult, but keep trying. Most of the smokers who have been successful in quitting, as you may know, tried multiple times.
Please keep us posted! Thanks for your comment!
Ashley, if you decide to try e-cigs, here’s a few tips:
1. Don’t fall for a “free trial”…they tend to be low quality and usually try to route you into buying pre-filled cartridges that you mary not like put need and it ends up being a lot more expensive. Instead…
2. Look up reviews on Youtube and/or on the e-cigarette-forum before buying to avoid wasting money on shoddy products or vendors with poor customer service.
3. Although many people think they’ll want something that looks like a cigarette, most eventually move up to something with better battery life/performance. Models like the “EGO” (AKA inferno, Riva, or tornado…depending on the vendor) are a good balance since they are only slightly larger but last about 4 times longer…some even allow you to connect a usb cable to recharge while you use it. (called “passthru”)
4. Although some vendors want you to buy only their prefilled cartridges, you can almost always refill yourself to dave money and try “e-liquids” from different makers or even learn to mix itt yourself to save even more money.
Nearly every aspect of vaping is customizable, so if you haven’t found a combination of vaporizer and e-liquid that produces a flavor, “throat hit”, and vapor production that you like BETTER than smoking…you need to keep looking!
Good luck finding a smoke-free alternative that suits your individual taste! Don’t be afraid to ask questions–vapers who have finally found a way to stop smoking without becoming miserable are some of the most friendly, helpful, and generous people you will ever meet!
Happy (Vapor) Trails!
-Thad
I am very grateful for your input Thad! I will have this in mind while I make the change. I am so glad I found this blog. The recommendations and information provided by Medbonsai as well as its readers is priceless.
Hello, I am 45 yr old femal and have been smoking about 1/2 pack a day for the last 10 years. I have tried NRS without any luck and honestly do not want to try chantix or anti depressants. I want to try an electronic cigarrete and started doing the research and stumbled with medbonsai. The blog has definitely helped me as well as the comments from all the users.
I was hoping that maybe some of the users can help and recommend a particular brand? Where should I buy them? etc any information is useful
Thank you
Anne
Hello Anne. I have been vaping for nearly 2 years and one thing I can tell you is that everyone had different favorites. It really depends on the person. Some questions to ask yourself before purchasing:
1. Is cost most important than convenience?
2. Is ease of use more important than performance?
3. Is battery life going to be more important or smaller size?
While ecigs come in a lot of sizes and different variations, here are my recommendations:
The Riva (also called ego) have a good battery life but is bigger than the smaller 1 hour batteries. It uses the “510” model parts, which is by far the most popular in the industry. You can use “atomizers” with a cartridge or “cartomizers” which are disposable atomizers combined with the cartridge in 1 piece. If you go with atomizers I would recommend learning the “Drip” method which means you just drip a few drops of liquid on the atomizer every 5-8 puffs. This will give you maximum flavor from the liquids and great vapor. But it is not really convenient. The other option is xxl dual core cartomizers which I have found to be closest to the “drip” method but they last hours after filling. So they are extremely convenient. These will require the EGO or Riva battery to work properly.
Last but not least we have the standard KR808 model with has cartomizers that you buy pre-filled with liquid. When it stops working well, you throw away the cartomizer and put another one on. This is by far the most convenient model there is available. Some really like this model ( while I prefer the Riva ).
Anyway, the only other option that I would recommend for a beginner is a standard “510” kit. It comes with 2 small batteries, 2 atomizers, 5 prefilled cartrides and a charger for usually around $30-$40 dollars. This 3 piece unit is pretty close to the size of a real cigarette, but the batteries only last an hour or so. They do charge back up in about 40 minutes, so you can swap them out every hour, but it can become a pain pretty fast.
Hope this helps.
Eric
P.S. I would recommend the Riva kit from liberty-flights.com with a smoktech 1.5ohm XXL cartomizer from tastyvapor.us. You can also find some great tasting juices from Tastyvapor.
For more info go to the Electronic Cigarette Forum (ECF) as there is a TON of info there.
Success Story
I’m 25, and have been smoking a pack a say since I was 14. In that time period, I don’t think I went more than a day or two without having a cigarette.
Two years ago I finally wanted to quit so I bought “clove” cigarettes. They worked for a few hours, until I realized how disgusting they were. So I tried a nicotine inhaler – such a waste of money. Gum and patches did not reduce my craving one bit. So I went on Champix. I started it in April, and for almost five months I didn’t have a cigarette. And then university started up again and the urge to smoke took over. And I began smoking again.
I bought my first e-cigarette two weeks ago. I’m live in Canada so I wasn’t able to find “e-liquid” that contained nicotine. That was OK for me, I had not intended to quit; I just wanted to try this cool new qizmo. From day one of owning this device I have not have a cigarette, or even an urge for one.
I have fairly bad asthma, and for a while now I’ve needed much more of my inhalers than I should be. Since switching to vaping, I haven’t needed my puffer once. It’s not surprising: smoking is not good for asthma. I just never thought I would notice just an enormous change that quickly.
The method I use involves dripping a few drops of flavoured e-liquid onto the heating element inside the cigarette each time I would normally have a smoke. It takes about the same time as fiddling with a pack, finding and then managing to get the damn lighter to work and it has now become a part of my smoking [vaping] routine.
I have now convinced my entire family to switch over to try and quit.
Bottom line: If you’re a smoker and have tried everything to quit…GET ONE! Try one, see if it’s right for you. There’s demo devices out there that are the price of a pack of cigarettes. There’s no excuse!
Congratulations Rory! Awesome work and thank you so much for sharing. Cases like you help motivate others to try and quit smoking. The feedback from everyone in this room is helping me as well as the people who smoke evaluate this “relatively new” option to stop smoking or at least change smoking habits. You are young and without a doubt changing this habit will improve your quality of life in the years to come.
Please continue sharing your experiences and keep up the good work!
😦
http://www.heraldextra.com/news/opinion/utah-valley/where-there-s-no-smoke-there-may-still-be-harm/article_36388c29-cc40-5e8d-9a20-7384cecb7bea.html
Go get um.
Hello Guys. So I recently created a Virtual Magazine at Zeen.Com and it has had great response. Reviewing recent information on E-Cigs. Information like that presented in the European Society of Cardiology:
Check it out and share at http://zeen.com/read/OQbksu?utm_campaign=issue&utm_medium=onsite&utm_source=profile
Great post. I was checking continuously this blog and I’m impressed! Very helpful info specifically the last part 🙂 I care for such information much. I was looking for this particular information for a long time. Thank you and good luck.
I am addicted to nicotine. Let’s get this right upfront. I have a 50 pack year smoking history and have tried everything to quit including acupuncture and hypnosis. Within 2 weeks post quit date I was back to one, then five, then ten; you all know this routine. I have the utmost respect for those fortunate enough to have no addictions. Not to alcohol, nicotine, sex, coffee, ice cream, etc. I gave the e cigarette a try with no illusions that it was anything but a nicotine delivery device that closely simulated the real deal. All the hand to mouth gratification, drags, throat hit and satisfaction. I did a lot of research into the types of e cigarettes and what made up the e liquid and harm reduction. My major concern was quality control for the e liquid. I chose to buy from vendors who had strict control processes in place and USDA approved ingredients. So here I am a year without burning a cigarette. I have reduced my nicotine content from 18 mg. to 12. Can I really state use of the e cigarette is better than complete abstanance? No. Do I believe using one is much better than the real deal? Yes. Based on research. Based on how I feel. Can I say that e cigarettes helped me quit burning tobacco in little white tunes? Absolutely. Do I feel I can use my e cigarette freely where ever I want? Absolutely not. I hate the politics swirling around the e cigarette. Can we expect the FDA and anti-tobacco legislators to listen to reason, to hear our stories, to make educated decisions? I would hope so. But then again I believe in Santa and the Easter Bunny.
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