2023-08-25 13:48

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Is The E-cigarette The New ‘Tobacco Industry Scandal’ Waiting To Surface
After The Health Damage Is Done?

Updated August 2023

Chris Ingram, Unionsafety Website Editor reports:

Once again the smoke screens over possible health issues regarding nicotine and smoking are being erected as the new E-Cigarette industry starts to flex its muscles, campaigning against regulation, claiming jobs are threatened and that there are no safety issues around E-Cigarettes.

They are also using emotional blackmail by saying any attempts to regulate the industry will stop millions of smokers from taking them up and no longer being exposed to the 4000 harmful and carcinogenic chemicals in normal cigarettes.

The E-cigarette lobby is also claiming thousands of users are quitting smoking as a result of their product – facts that cannot in anyway be borne out.

In fact, there is evidence that people who never smoked before are taking up E-cigarettes and therefore becoming addicted to one of the most addictive chemicals, nicotine. Further, as with alco-pops, the manufacturers of E-cigarettes are making fruit and sweat flavoured products which are targeted at young people.

As if to bear this out, the BBC reported in February this year that a woman now using e-cigarettes told them the e-cigarette has helped her to stop smoking. "I've tried patches and inhalators," she says. "They're a lot better because you feel like you're having a cigarette." With another woman saying: "They're a great idea. You've got the health benefits from it and it does taste like a cigarette."

From YouTube this comment following a video extolling the virtues of e-ciggs from one of the 'next generation nicotine vapourers' as opposed to smokers: "Just quit smoking ciggs and started vaping June 1st so in just 4 days I find there is so much to learn so it's still over my head a bit will have to watch this a few times to make sense of it all feeling so lost but enjoying vaping."

Currently being available anywhere with no age restrictions on whom they can be sold to, any opportunity to regulate them as a medicine and restrict the age of exposure to nicotine; will not be available until 2016 the earliest.

See 'Regulation Update' further down this page.

By then it is feared that hundreds of thousands of young people and adults who have never smoked before will have tried E-cigarettes and will be addicted to nicotine as a result. Furthermore, as there is no regulation of them, the level of nicotine delivery varies from one type of e-cigarette to another; and no way of stopping dangerous inferior models being imported and put on sale in the UK.

Whilst the health and safety issues around the contents of E-cigarettes are only just being discussed by our government, countries such as Australia and Austria have already done so and banned their use and sale. However, in Holland and Germany, manufacturers of the nicotine delivery system that is an e-cigarette, successfully overturned in the courts; their government's previous assigning the product as a medical device.

In the UK, the government is following the USA and has pronounced that they intend to enforce regulation upon the E-cigarette industry through licensing and applying the same restrictions as for that of normal cigarettes.

American Cancer Society says that there is a lack of evidence to show its health benefits or indeed the safety of using them, with the US Food and Drug Administration (FDA) banning them from being imported into the country.

The FDA have gone further as reported previously by Unionsafety and issued a report that claims they are unsafe due to the presence of chemicals used to make anti-freeze!

Here last Friday 21st June, the issue was discussed on BBC’s North West Tonight programme, but with interviewees falsely claiming that people have used them successfully to give up smoking altogether; and that they are a good tool to use instead of normal cigarettes in order to cut down and eventually stop smoking.

No evidence exists to that affect, and on the contrary evidence points to individual smokers using both forms of nicotine delivery, and not ceasing at all.

But that didn’t stop the spokesperson from a major manufacturer in the North West from also claiming they are used to stop smoking altogether. A clever use of words, with them argueing they mean 'conventional smoking'.

These statements sadly, were not challenged by the programme, although they did include comments from those agreeing with the government’s statement that they will need to be licensed as a medical product and limited to the sale of over 16 yr olds as is the case now with normal cigarettes.

A simple check via Google brings up the fact that the majority of comments and videos applauding E-cigarettes are from smokers who say how they’ve cut down on tobacco products and use either both the E-cigarette and fewer normal cigarettes, or have transferred over to the E-cigarette totally. But, finding those who claim to have stopped both seems to be a problem.

In fact it has now become a ‘hobbyist’ activity with its own slang and is now known as ‘vaping’ as opposed to ‘smoking’. An example can be watched here This shows that E-cigarettes are far from the ‘quit smoking’ aid that was claimed on the BBC North West Tonight programme, but is a whole new 'hobby' flourishing around the world.

The programme did challenge the fact that given the varying flavours now being rolled out and widely advertised, that children and non-smokers are trying them out and given the efficacy of nicotine in terms of its addictive nature; the industry may well be creating a whole generation of people addicted to the E-cigarettes.

It can of course be argued that because manufacturers are against regulation and producing flavoured E-cigarettes, they are knowingly creating a guaranteed future consumption of their product in the next and future generations.

As there was with bans on the use of tobacco cigarettes in pubs and all enclosed spaces, so too there is a major outcry about any regulation of this new smoking phenomenon, with manufacturers and users setting up campaign groups opposing any regulation at all!

In fact the manufacturers are taking out newspaper ads and on-line ads posed as news items but which are simply advertisements.

Pic: BBC news item - click to readThe BBC North West Tonight programme was in the main balanced. However, to interview a doctor who praised the product even before there has been any real serious examination and peer-reviewed evidence of the health implications of the product was quite irresponsible.

The sorry history of alco-pops and the tobacco industry provides lessons that people clearly have not learned.

I have raised my objections direct with the makers of the programme, BBC TV and await a response. [update: none was ever received]

In the USA there are many physicians who are calling for a ban on the E-cigarette altogether, or at least tough regulation. Watch here

Many commentators now argue that the vapour in the product produces harmful chemicals and have never been tested and doubt the efficacy of the product in helping people quit smoking. In fact, they argue, people are simply swapping one addiction for another. Indeed, one GP proponent of supplying them to smokers as aid to quit smoking admits that the exhaled mist contains 1% nicotine; which means second-hand 'vapour' from the product can be inhaled by those nearest to the user of such products.

However, there is another argument of course that says because there is no tar and none of the 400 other harmful chemicals within normal cigarettes; there may well be long-term public health benefits from people switching to electronic cigarettes.

Professor John Britton, who leads the tobacco advisory group for the Royal College of Physicians was quoted in February this year by the BBC as saying:

"Nicotine itself is not a particularly hazardous drug. It's something on a par with the effects you get from caffeine. If all the smokers in Britain stopped smoking cigarettes and started smoking e-cigarettes we would save 5 million deaths in people who are alive today. It's a massive potential public health prize."

However, the toxicology of nicotine itself points to it being a totally harmful substance, whilst not being delivered in the amount required to cause harm in conventional cigarettes. E-Liquid, (liquefied nicotine) used in the delivery system of E-cigarettes, is another thing altogether and has the potential to cause nicotine overdose, which can lead to death.

But the key ingredient in the electronic cigarette, apart from nicotine, is Propylene Glycol which is used to hold the liquid nicotine which is then heated up to produce the smoke that smokers are used to and without which the developers of e-cigarettes think would result in a far lower uptake of smokers transferring to the electronic from the conventional and far more hazardous tobacco cigarette.

The US Food and Drugs Administration (FDA) has implemented a ban on imports of e-cigarettes in the USA and issued a warning of potential health problems, as a result of their tests on 19 different brands of e-cigarette showing the presence of carcinogens; cancer causing compounds called nitrosamines. They also contain levels of diethylene glycol, used in anti-freeze said the FDA.

Pic: graphic of parts of an e-cigaretteThe use of cheaper grade Propylene Glycol may be the source of this, but nevertheless no one is denying that these chemicals which are found in anti-freeze, are also found in electronic cigarettes.

With the lack of any regulation of the industry and varying quality of manufacture; there is currently no way of knowing which brands contain the least carcinogens or give out the most nicotine and vapour.

As expected, and as with normal cigarettes, the industry is fighting back. It claims that the FDA's ban is sending out the wrong message. "It is likely to force e-cig users back to using conventional cigarettes, with their well known serious health problems. That could be more dangerous to health than anything indicated by testing electronic cigarettes so far.", says Electronic Cigarette Direct on their website and quoting the American Association of Public Health Physicians as the source.

Much has been made by promoters of so-called "safe non toxic" personal care toiletries and cosmetics of the potential dangers of known "safe", yet perhaps toxic chemicals such as Propylene Glycol and Ethylene Glycol, a related chemical.

Although exposure to high levels of Propylene Glycol is known to cause serious and potentially irreversible health conditions, the chemical industry tell us that "small" quantities or low level exposure of Propylene Glycol is "safe" to use on the skin and in food. But no one mentions of course either the amount that is absorbed into the body over a lifetime of use, nor the 'cocktail effect' upon the thousands of other chemicals humans ingest in their food and absorb from the environment.

According to the safety data sheets of industrial chemical manufacturers, chemicals such as Ethylene Glycol and Propylene Glycol will cause serious health conditions, including liver and heart damage and damage to the central nervous system if sufficient is absorbed by the body.

Consumers need to make their own minds up about putting a "safe" chemical such as propylene glycol on their skin every day or eating food with it in.

REMEMBER: Cigarette manufacturers denied any health risks associated with toxic chemicals contained in cigarette smoke for over 25 years! Could the toxic chemicals we are exposed to on an everyday basis be the next "tobacco scandal"?

Pic: Daily Telegraph report - click to go websiteAs for the Government’s response which seems likely to agree that E-Cigarettes are an alternative to smoking which can be of benefit, even before the jury is out on the safety of using them; the Daily Telegraph reported this weekend that the government are doing precisely that.

Furthermore, they are talking about allowing GPs to prescribe them on the NHS for people who are simply wishing to cut down on their smoking, but not quitting altogether!

“GPs will be able to prescribe e-cigarettes, which let users inhale a mist of nicotine instead of tobacco smoke, once they have been licensed by the Medicines and Healthcare products Regulatory Agency (MHRA).

The battery-powered devices, which are used by an estimated 1.3 million people in Britain, typically cost around £40 for a starter kit and then up to £17 for refill packs.

Experts have calculated that millions of lives could be saved if all smokers switched to e-cigarettes because they do not contain harmful tar.

However others have raised concerns about their safety and regulation, suggesting that users cannot be certain about the amount of nicotine that they contain.

The MHRA said that all e-cigarettes and other nicotine-containing products would have to be licensed by 2016, but manufacturers can apply for licences before then.”

The response from the industry is of course not entirely one of agreement and pleasure over the idea of regulation:

“Adrian Everett, chief executive of e-cigarette manufacturer E-Lites, warned that the new licensing regime could force the industry into the hands of the big pharmaceutical and tobacco companies.

He told the Telegraph: "This is a consumer-driven phenomenon that hasn't been supported by big tobacco. We have created and developed a product and brought it to a good standard.

"Now there is a big risk that north of 80 per cent of e-cigarette companies will not be able to afford the process they are talking about introducing. We'll be OK, but it could cost up to £1 million to get a licence, to provide them with the information.

That would be financially prohibitive for companies that are perfectly acceptable and cannot afford to go through this process.

We don't want to see big pharma and big tobacco coming in and taking over. There is very much a feeling this could push e-cigarette companies into the hands of pharmaceutical companies who have much more experience in achieving medicinal authorisations."

Pic: E-cigarette advertisementBut the issue of GPs prescribing them for those who only wish to cut down is perhaps one of the most controversial aspects of the Government’s stance.

The Telegraph report states:

“Once a device is approved, individual GPs and smoking cessation advisors will be able to prescribe it to people who are trying to give up smoking.

However, e-cigarettes will not be prescribed on a widespread basis across the NHS unless the National Institute for Health and Clinical Excellence (Nice), the public health watchdog, backs their use over other means of helping smokers kick the habit.

Last week Nice issued new guidance which made Britain the first country to recommend that licensed nicotine-containing products can be prescribed to people who only want to reduce the number of cigarettes they smoke, not quit entirely.”

But there is a warning in the results of the minimum research done so far into E-Cigarettes:

MHRA research into e-cigarettes found that the amount of nicotine they contained could be "considerably different" from the level stated on the label, and could differ from batch to batch.”

Whilst the US FDA and the World Health Organisation have both issued bans on E-Cigarettes because of the fact that they contain levels of carcinogens and that there is no proof they help people cut down or stop smoking altogether; the UK's Action on Smoking and Health (ASH) have issued a report this month, stating their support for the use of e-cigarettes because "There is little real-world evidence of harm from e-cigarettes to date, especially in comparison to smoking."

Their conclusion states:

"ASH believes that e-cigarettes, properly regulated to ensure product safety, quality and efficacy, should be made available as part of a harm reduction approach to tobacco."

In a stance that will surely undermine smoke-free legislation Ash end their report with this:

"In the UK smokefree legislation exists to protect the public from the demonstrable harms of secondhand smoke. ASH does not consider it appropriate for electronic cigarettes to be subject to this legislation."

Their 8 page report also says,

"Indeed, the harm from smoking is caused almost exclusively by toxins present in tobacco released through combustion. By contrast, pure nicotine products, although addictive, are considerably less harmful. Electronic cigarettes consequently represent a safer alternative to cigarettes for smokers who are unable or unwilling to stop using nicotine."

Pic: ASH report into e-cigarettesOn the question of exposures to propylene glycol, the ASH report says there is little to worry about:

"Any health risks of secondhand exposure to propylene glycol vapour are likely to be limited to irritation of the throat. One study exposed animals to propylene glycol for 12 to 18 months at doses 50 to 700 times the level the animal could absorb through inhalation. Compared to animals living in normal room atmosphere, no localised or generalised irritation was found and kidney, liver, spleen and bone marrow were all found to be normal."

But there is no mention of the levels of nicotine in the vapour given off.

Update August 2023

Since that statement made by ASH in June 2013, medical evidence and media reports show their statement to have been rather premature to say the least.

Countless reports both in the UK and US media have reported on lung complications (popcorn lung) requiring hospital treatment, death due to long-term use of vapes, and even one suicide of a vaper who swallowed the liquid nicotine from their e-cigarette. Yes nicotine can kill, taking less than 10 mils of it in liquid form is enough to do so.

The danger to human health/life that is posed by nicotine is discussed further down this page.

Research also shows that the chemicals used in 'flavouring' e-cigarettes, many of which are along with nice shiny colourful packaging, are aimed at children. Furthermore, many of these chemicals were never intended to be inhaled, with some even being carcinogenic.

One question of course is that given e-cigarettes contains propylene glycol, in the context of the workplace, surely the electronic cigarette, the vapour of which given off contains propylene glycol, and not mere water vapour as is claimed to be the case by the manufacturers; would place its use in the workplace within the CoSHH regulations?

Clearly the view expressed by Hugh Robertson of the TUC as reported by this website here that E-cigarettes have no place in the working environment, is one that all those concerned with health and safety in the workplace, and in their homes and enclosed public areas; believe should prevail until complete and independent testing of electronic cigarettes has taken place and the findings subjected to peer review.

Update 2018:

Since writing this report, I have uncovered a study entitled 'Randomised Controlled Trial Investigating the Efficacy and Safety of an Electronic Nicotine Delivery Device (E-Cigarette) in Smokers' carried out by two scientists from the University of Catania, Italy, using a study group of 300 Italian smokers who had no intention of giving up smoking.

Whilst the research was supported by a grant-in-aid from Lega Italiana AntiFumo by one of the major e-cigarette manufacturers and suppliers in Italy (Categoria™ e-Cigarette), and that both have connections with major pharmaceutical companies, Pfizer and GlaxoSmithKline and the Pfizer and Arbi Group Srl, the distributor of the Categoria™ e-Cigarette; there is no suggestions that the sponsors have been involved in any way with the research study and findings as presented in the report published on 24th June 2013.

The study conclusion is that "in smokers not intending to quit, the use of e-cigarettes, with or without nicotine, decreased cigarette consumption and elicited enduring tobacco abstinence without causing significant side effects."

The study supports the view of ASH as detailed above.

Pic: Study report into e-cigarettes - click to downloadHowever, the study did not look into the chemicals present in E-cigarettes, nor did it address the many variations in quality of products, the varying levels of nicotine that they deliver to the user; nor the chemical make-up of the vapour that is given off by the product and potentially inhaled by those within the vicinity of the e-cigarette user.

In presenting the study results, the authors point out that further study is required and that it is up to the industry to prove to the regulators that only water is present in the vapour e-cigarettes give off.

Interestingly, the study report authors support regulation:

"Obviously, these products need to be adequately regulated. Thus far, there have been heterogeneous regulatory responses ranging from no regulation to complete bans."

They explain the background to the study:

"Electronic cigarettes (e-cigarettes) are becoming increasingly popular with smokers worldwide. Users report buying them to help quit smoking, to reduce cigarette consumption, to relieve tobacco withdrawal symptoms, and to continue having a ‘smoking’ experience, but with reduced health risks. Research on e-cigarettes is urgently needed in order to ensure that the decisions of regulators, healthcare providers and consumers are based on science."

This is the longest study done into the use of e-cigarettes as a substitute for tobacco based cigarettes, lasting 12 months and taking place in 2010/11.

A study in Sweden into the chemical compounds found in the liquid nicotine and the quality of the nicotine delivery used in E-cigarettes is awaiting its results publication. Further, warnings on the new trend of nicotine extraction by hobbyists have been issued which alerts people to the very harmful effects of nicotine on humans and comes from the Organic
Gardening Encyclopedia:

"Nicotine: An extract of tobacco, nicotine can be used as a poison contact spray for sucking insects such as aphids. In the concentrated form in which it is sold, it is highly dangerous to human beings; even physical contact is dangerous. Nicotine in a sulphate solution is sometimes used to control serious insect infestations."

Even physical contact with nicotine extract, via spilling for example or breaking of the e-cigarette containing the liquid; can mean serious trouble:

"Dermal exposure to nicotine can lead to intoxication. Such exposure has been reported after spilling or applying nicotine-containing insecticides on the skin or clothes (Loockhart, 1933; Benowitz, 1987), and as a consequence of occupational contact with tobacco leaves (green tobacco sickness) (Weizenecker, 1970; Gehlbach, 1974)."

Update 2023: E-Cigarettes and use by Children

According to research concluded by ASH (Action on Smoking and Health) in March/April 2023 the proportion of children experimenting with vaping had grown by 50% year on year, from one in thirteen to one in nine. Children’s awareness of promotion of vapes has also grown, particularly in shops where more than half of all children report seeing e-cigarettes being promoted, and online where nearly a third report e-cigarette promotion. Only one in five children now say they never see vapes promoted, down from 31% last year.

It is an offence to sell e-cigarettes to children under 18 in the United Kingdom and children means those aged 11-17 years old, unless otherwise specified. However, where are the enforcers of this law, and the subsequent prosecutions?

image: ASH report into children vaping - click to download from E-LibraryTheir report also provides interesting stats about how children get into vaping and have access to the 'vapes':

The most frequent source of vapes is shops (48%), closely followed by given (46%) and informal purchase (26%). Multiple options were allowed, and fewer than one in ten (7.6%) gave the internet as a source.

In 2023 69% said the most frequently used device was a disposable (single use) vape up from 52% in 2022 and 7.7% in 2021. The most popular brand was Elf Bar.

The most popular flavours are fruit (60%), followed by sweet or soft drink (25%).

There has been a significant growth in awareness of e-cigarette promotion between 2021 and 2022 with more than half all children (53%) aware of promotion in shops, and nearly a third (32%) online. Only one in five (20%) say they never see e-cigarettes being promoted, down from 31% last year.

Although selling vapes to children is illegal, giving them out for free is not, and it is of concern that 2.1% of children who have ever tried vaping, report that their first vape was given them by an e-cigarette company. There are wide confidence intervals so this could range between 9.000 and 38,000 children in Great Britain.

Regulation update: ASH June 2023

From October 2015 a minimum age of sale for e-cigarettes of 18 was introduced in England and Wales, making it illegal to sell e-cigarettes containing nicotine to under 18s or to purchase them on behalf of under 18s.

However, a loophole in the law does not make it illegal to give free samples of e-cigarettes to under 18s. Scotland implemented their own age of sale and proxy purchasing regulations in April 2017, and Northern Ireland in February 2022.

From 20th May 2016, a regulatory framework for e-cigarettes was introduced in the UK under the EU Tobacco Products Directive (TPD). From that date, the advertising or promotion, directly or indirectly, of electronic cigarettes and re-fill containers on a number of media platforms, including on television, radio, newspapers and magazines, was prohibited.

The only advertising still allowed is at point of sale and other local advertising such as billboards. Scotland is currently in the process of consulting on whether to tighten its regulations to further limit the way vape products can be advertised and promoted.

The new product rules under the TPD for e-cigarettes introduced a notification process for manufacturers and importers in May 2016. Non-compliant stock was allowed on sale for a further year until 20th May 2017.

You can download the report from ASH entitled 'Use of e-cigarettes (vapes) among young people in Great Britain' from the unionsafety e-library. Use search words 'ASH' or 'vapes.'

Further details about the dangers of nicotine can be accessed here

You can view further information about Propylene Glycol and also download the ASH report into e-cigarettes, from the E-Library Database here

You can also download the Italian university study into E-cigarettes from the E-Library Database by using search word 'ECLAT' here

Source: TUC / Daily Telegraph / Unionsafety / Health-Report UK / U.S. Department Of Health And Human Services / Electronic Cigarette Direct / ASH / US Food and Drugs Administration / BBC TV / YouTube / Plusone / Organic Gardening Encyclopedia / Inchem / Julia Higa de Landoni

Pic: Bak to News icon link

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