Comparison of Carcinogen Levels Shows that Electronic Cigarettes are Much Safer Than Conventional Ones

Thursday, July 3 , ! "

The FDA last week condemned electronic cigarettes on the basis that an FDA laboratory detected carcinogens (tobacco-specific nitrosamines) in the cartridges of several electronic cigarette manufacturers. The FDA held a press conference in which it attempted to scare electronic cigarette users into discontinuing e-cigarette use (and therefore a return to conventional cigarette smoking). n addition! a number of anti-smoking groups! including the "ampaign for Tobacco-Free #ids and American $ung Association! have called for a ban on these products due to this carcinogen scare. The FDA (and the anti-smoking groups)! however! failed to do three important things% First! they failed to disclose the levels of tobacco-specific nitrosamines that were detected in the electronic cigarette cartridges. &econd! they failed to test the control product (a nicotine inhaler) to determine the carcinogen level in that product. Third! they failed to report the tobacco-specific nitrosamine levels in conventional tobacco products! including cigarettes. The Rest of the Story 'ecause of the FDA(s and the anti-smoking groups( omissions! there is a need to get the rest of the story out there to the public. And here it is! in this table%
Maximum Tobacco-Specific Nitrosamine Levels in Various Cigarettes and Nicotine-Delivery Products ng!g" except for nicotine gum and patc# $#ic# are ng!patc# or ng!gum piece% Product NNN NN& N'T N'( Total

)lectronic cigarettes *%

+,-.

/,01 Not detected

*,/1 Not detected

2,13+ Not detected

-,/-+ *,222

Nicotine gum /% *,22

Nicotine patc# /% S$edis# snus +% 4inston /% Ne$port /% Marlboro +% Camel /% S6oal /% Marlboro /%

Not detected **22 //22 +/22 0522 0+22

-,22

Not detected 512 /322 *-22 0/22 0322

Not detected *5 55 /52 **2 /32

-,222 *022

5-2 -+2 /022 0.2 /-22

++15 +--5 1122 .052 3*32 //"/32

Sources: 1. Stepanov I, Jensen J, Hatsukami D, Hecht SS. Tobacco-specific nitrosamines in new tobacco products. Nicotine & Tobacco Research !!"# $:%!&-%1%. '(ink) . (au*esen +. Safety Report on the Ruyan e-cigarette Cartridge and Inhaled Aerosol. ,hristchurch, -ew .ea/and: Hea/th -ew .ea/and (td, !!$. '(ink) %. 0ah/ber* I. Tobacco-specific Nitrosamines in Unburnt New ealand Tobaccos! Report to "ealth New ealand #td. Swedish +atch, !!1. '(ink)

As these data show! the level of tobacco-specific nitrosamines present in electronic cigarettes is at the trace level. t is measurable in parts per trillion (nanograms per gram). t is comparable to the nitrosamine levels in nicotine replacement products which are approved by the FDA. n contrast! the level of tobacco-specific nitrosamines present in tobacco products are )** to +,** times higher. -n a weight-for-weight basis! .arlboro has +,** times higher the level of tobacco-specific nitrosamines than an electronic cigarette cartridge. And keep in mind that these represent the levels in the cartridges and cigarettes! not in the tobacco smoke or e-cigarette vapor which are directly inhaled. 'ecause of the much higher temperatures generated in tobacco combustion compared to propylene glycol vapori/ation! the delivery of these carcinogens into the vapor is e0pected to be much lower than into the tobacco smoke. .oreover! there are appro0imately 56 other carcinogens that have been identified to be present at high levels in tobacco smoke! while there are no other carcinogens that have been identified to be present in electronic cigarettes. 'ased on these data! and upon knowledge that the conventional cigarette contains at least +*!*** other chemicals! including known to0ins and carcinogens! while the electronic cigarette does not! there is e0ceedingly strong evidence that electronic cigarettes are much! much safer than conventional ones. This does not mean that there are not issues that need to be addressed with

electronic cigarettes. The diethylene glycol that was present in one cartridge tested suggests that more widespread and systematic testing should be done to identify the e0tent of this problem. Testing is also necessary to determine whether the diethylene glycol actually makes it into the e-cigarette vapor1mist. The problem should be able to be addressed easily! since high-grade propylene glycol - which is almost entirely free of diethylene glycol - is readily available. Appropriate procedures also need to be in place! if they are not already! to ensure that electronic cigarettes are not available to minors. 2owever! what this calls for is the FDA working with the electronic cigarette manufacturers and distributors to study the product and address the identified problems. t does not call for the FDA to ban the product or pull it from the market. This research is not the only work that has established that electronic cigarettes are much safer than conventional cigarettes. 3esearch conducted by Dr. .urray $augesen and 2ealth 4ew 5ealand $td. reveals that the to0ic emissions score for electronic cigarettes is much lower than that of conventional cigarettes. n fact! the to0ic emissions score - which is a score based on the levels of 67 priority to0icants was zero for electronic cigarettes. n contrast! it was +89 for .arlboro and it was no lower than +** for any brand of conventional cigarette tested. 4ote that the above study actually tested the electronic cigarette vapor. This is the most relevant test! because it determines what the user actually inhales. The study found no more than trace levels of any of the 67 priority to0icants. The study concluded% :3uyan; <= nicotine e-cigarette users do not inhale smoke or smoke to0icants. The modest reductions recommended in 8**= by >2-?s Tobacco 3egulation committee for 7 ma@or to0icants in cigarette smoke! in line with Articles 7 and +* of the F"T" (>2- Framework "onvention Tobacco "ontrol treaty)! are already far e0ceeded by the 3uyan; e-cigarette! as it is free of all accompanying smoke to0icants. Absolute safety does not e0ist for any drug! but relative to lethal tobacco smoke emissions! 3uyan e-cigarette emissions appear to be several magnitudes safer. A-cigarettes are akin to a medicinal nicotine inhalator in safety! dose! and addiction potential. A-cigarettes are cigarette substitutes. f they can take nicotine market share from cigarettes! and that is the big Buestion! they will improve smoker and population health. They may also have a secondary role as medicinal nicotine inhaler Buitting aids. Further trials of acceptability! addiction potential! clinical safety! and Buitting efficacy are needed.: t should also be noted that there is preliminary research which provides laboratory evidence that electronic cigarettes are as effective as nicotine replacement products for short-term smoking cessation (i.e.! these products have been shown to provide relief of cigarette cravings at a level comparable to nicotine replacement products). This research found that electronic cigarettes are actually preferable to a nicotine

inhaler in terms of helpfulness! pleasantness! and ratings of whether the smoker would use the product and recommend the product. Civen the overwhelming anecdotal evidence of the effectiveness of e-cigarettes for smoking cessation! formally studying the longer-term effectiveness of these products is a research priority. Alectronic cigarettes have the potential to be a life-saving intervention for millions of smokers. The FDA and the anti-smoking groups need to embrace this product and support the appropriate testing! not remove it abruptly from the market and sentence over a million e-cigarette users to disease and even death by a return to conventional cigarettes.

Dr. &iegel is a Drofessor in the Department of "ommunity 2ealth &ciences! 'oston Eniversity &chool of Dublic 2ealth. 2e has 86 years of e0perience in the field of tobacco control. 2e previously spent two years working at the -ffice on &moking and 2ealth at "D"! where he conducted research on secondhand smoke and cigarette advertising. 2e has published nearly F* papers related to tobacco. 2e testified in the landmark Angle lawsuit against the tobacco companies! which resulted in an unprecedented G+,6 billion verdict against the industry. 2e teaches social and behavioral sciences! mass communication and public health! and public health advocacy in the .asters of Dublic 2ealth program.

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