Shortly after the FDA press release "Public Health Experts Warn About Electronic Cigarettes," an electronic cigarette user walked into a cigar shop. "Hey man, you've got to stop using that thing," said the clerk. "The FDA says electronic cigarettes cause cancer."
So what is an electronic cigarette? Does it really cause cancer? What did the FDA really say?
The electronic cigarette, also called the e-cigarette, was invented in China approximately five years ago. The purpose was to provide a smokeless alternative that would be acceptable to tobacco smokers as well as to non-smokers bothered by second-hand smoke.
The product consists of a battery, an atomizer, and replaceable or refillable cartridges. Cartridge ingredients typically consist of propylene glycol (PG), water, nicotine, and flavoring. When the user inhales, some of the liquid in the cartridge is vaporized by the atomizer. The PG generates an odorless mist that evaporates within a few seconds. This is the same chemical used in machines that produce simulated smoke or fog for stage productions and dance clubs. PG is not a carcinogen.
Users can select a level of nicotine for the cartridges. Levels range from 0 to 24 mg nicotine. Depending on the model, each pre-filled cartridge is equivalent to a half-pack or a full pack of tobacco cigarettes. Nicotine is not a carcinogen.
Chinese smokers were quickly captivated by the idea of a cigarette that provides nicotine, but does not burn, contains no tobacco, and produces no smoke. The product spread to Europe, where it has been in general use for about two years. One company began marketing an electronic cigar in the US in 2007, followed by a cigarette version in 2008, sold via the Internet. By early 2009, one brand was being sold in shopping center kiosks. Another brand became available though several retail outlets.
What did the FDA really say? The FDA announced that a laboratory analysis of electronic cigarette samples found "carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze." Predictably, the public interpreted this to mean that there is immediate danger of contracting cancer from, or being poisoned by, electronic cigarettes. Many smokers formed the opinion that the FDA was encouraging them to stick with smoking tobacco.
Dr. Elizabeth Whelan, president of the American Council on Science and Health, called the FDA statement "distorted, incomplete, and misleading." She pointed out that traditional cigarettes are lethal because smokers inhale enormous amounts of "products of combustion", and it is the inhaled smoke that kills, "from cancers, cardiovascular disease and lung disease, and more."
Dr. Michael Siegel, professor at Boston University School of Health stated, "At the same time that the FDA made a big hullabaloo over the finding of traces of carcinogens in electronic cigarette cartridges, the FDA hid from the public the fact that it would be nearly impossible not to have detected these carcinogens in the cartridges because the nicotine is derived from tobacco and there are residual traces of carcinogens even in nicotine replacement products."
Nick Westenberger who directed the cartridge testing for FDA said, "These impurities have well defined specifications in the FDA approved smoking cessation products but not in these." Mr. Westenberger did not reveal the quantities of impurities the FDA allows in its approved smoking cessation products, nor how those quantities compare with quantities in the e-cigarette cartridges. The final FDA lab report does not list quantities of the substances found, only whether they were detected ("D") or not detected ("ND"). Even though an FDA-approved Nicotrol inhaler cartridge was used in the testing, no information was provided on whether the substances were detected or not in the approved product.
Diethylene glycol (DEG) is a humectant added to tobacco to keep it moist. DEG is also added to to some personal care products. The World Health Organization tested DEG for acute toxicity on a number of animal species. The document "Toxicological Evaluation of Certain Food Additives" states, "No abnormalities were obvious below a dosage level of 1 ml/kg by any route."
The e-cigarette cartridges tested by the FDA can hold between 0.5 and 1 ml of liquid. The FDA testing found 1% DEG in one of the cartridges. It would take 100 of the 1 ml cartridges or 200 of the 0.5 ml cartridges to yield 1 ml of DEG. Therefore a 150-pound user would have to consume between 6800 and 13600 cartridges in a single day to take in a toxic level of DEG. On average, an e-cigarette user consumes one cartridge per day.
In contrast, the average number of tobacco cigarettes a smoker consumes per day is 20. The CDC's Environmental Health Laboratory reports that tobacco contains harmful substances including "nitrosamines; tar; pesticides; carbon monoxide; volatile organic compounds (benzene, for example); metals (such as cadmium and radioactive polonium); carbonyl compounds; and polycyclic aromatic hydrocarbons."
Tobacco smoking is credited with 440,000 deaths per year.
In the five years that e-cigarettes have been in use in China, two years in Europe and the UK, and a year in the US, there have been no reported cases of cancer, no deaths, and no serious illnesses linked to the products.
Harm reduction researchers at the University of Alberta said, "Persuading smokers who cannot or will not quit using nicotine to switch to alternative sources is almost as beneficial to their health as getting them to quit entirely."
Despite the fact that the e-cigarette's purpose is not smoking cessation, thousands of people have reported being able to reduce or stop smoking tobacco cigarettes by switching to the alternative source of nicotine. Many reported measurable improvements in lung function and cardiovascular health. User comments can be viewed at the Electronic Cigarette Petition site.
References:
U.S. Food and Drug Administration, News & Events: "Electronic Cigarettes."
http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm1 72906.htm
Whelan, E.M., The Washington Times, August 6, 2009, "FDA smoke screen on e-cigarettes." http://www.washingtontimes.com/news/2009/aug/06/fda- smoke-screen-on-e-cigarettes/
Siegel, M., "FDA Lunacy: Product We Know Will Kill 400,000 People This Year - APPROVED; Product that May Well Help Prevent Many of Those People from Dying: BANNED." http://tobaccoanalysis.blogspot.com/2009/07/fda-luna cy-product-we-know-will-kill.html
Wikipedia, "Diethylene Glycol.". http://en.wikipedia.org/wiki/Diethylene_glycol
WHO Food Additives Series 10, "Toxicological Evaluation of Certain Food Additives." http://www.inchem.org/documents/jecfa/jecmono/v10je0 4.htm
Centers for Disease Control and Prevention, "Exposure to Tobacco Smoke and Harmful Substances in Tobacco." http://www.cdc.gov/nceh/dls/tobacco.htm
Heavner, KK, Rosenberg, Z, Phillips, CV, "Survey of smokers' reasons for not switching to safer sources of nicotine and their willingness to do so in the future." Harm Reduction Journal 2009, 6:14. http://www.harmreductionjournal.com/content/6/1/14
Tobacco Harm Reduction Organization, "Electronic Cigarettes, Frequently Asked Questions." http://www.tobaccoharmreduction.org/faq/ecigs.htm
The Electronic Cigarette Petition. http://www.thepetitionsite.com/1/keep-life-saving-el ectronic-cigarettes-available