One of the outstanding weaknesses in some recent research into e-cigarette use is the obvious lack of knowledge that some researchers and commentators have about the workings of vaping devices. indeed, whether by accident or design, some massive 'bloopers' have been made and those have had serious repercussions. How many smokers have disregarded alternative advice and have continued to smoke?
It is difficult for people who are in the front line: people who vape, to express their thoughts and counter the 'wittering's' of some experts. It is difficult for shopkeepers, hairdressers and used car salesmen to have their voices heard above the 'babble' of health professionals, politicians and media presenters all proclaiming loudly, this, that and the other.
Yet... Who are the experts when it comes to vaping? More importantly, are they really experts? Let us take a quick tour and have a look at what some 'experts' have said about vaping.
Let me start with what is to my mind, one of the 'daftest' ones. E-cigarettes may cause tuberculosis. That is correct, e-cigarettes may cause tuberculosis.
The following comment appeared in the Cape Bretton Post of 2nd January 2014. It was written by an 'expert.' (But not a medical expert)
“Now most of the e-cigarettes sold here are made in China, where there is very weak government regulation with respect to how they are made. The Canadian government does not know if Chinese workers making cigarettes wear masks. If they aren’t wearing masks, there are increased risks associated with tuberculosis.”
I spotted this at the time and wrote to the professor, pointing out that...
"This is just about one of the most ridiculous statements have ever come across. Pure, unsubstantiated scaremongering and an indication of the lack of care you have taken with your research.
There is a beautiful irony here. Some ‘idiot’ has reasoned that if there is tuberculosis in China, there must be a risk involved. You have decided to parrot this. And here is the irony! You see, the main ingredient in e juice is propylene glycol. Propylene glycol is a disinfectant. And, do you know what? It is used extensively in the war against… yes… come on now… Think! That’s it… Tuberculosis!"
Yes, I know, just because propylene glycol is a constituent in e-liquid does not mean it would prevent infection via vaping - but there again, there are, as far as I am aware, no cases of tuberculosis having been caused through vaping.
Anyway, I am not an expert. Oh! And you may have noticed that my propensity for using emotive terminology has not changed between my writing back then and now - I offer no apology even though scientists avoid doing this... or do they?
An emotive headline but did the researcher claim this? It would appear he did. “[Level of PAHs] in e-cigarettes is at least one million times more than roadside air in Hong Kong,” said Dr Chung Shan-shan, assistant professor in the university’s biology department." The study itself turned out to be 'pure garbage,' sorry, I must stop doing that. The study itself contained one or two weaknesses. No, back to my own style: It was not worth the paper it was written on, or perhaps I should say, the papers it was written in, because I am not sure if the research was ever published except in the world press.
It is not a one off... The New England Journal of Medicine [Published by Marvel Comics? I can say this because I am not an expert and have no ambition to have anything published in publications of disrepute] The New England Journal of Medicine published a report that started a media frenzy.
However, is was soon revealed that, once again there were major flaws.
Clive Bates said the following in his article, Spreading fear and confusion with misleading formaldehyde studies.
"This experiment, published in the New England Journal of Medicine, operated the vaping device at a such a high temperature that it produced thermal breakdown products (so-called dry puff conditions), but no user would ever be able to use it this way – the vapour would be too acrid. They went on to calculate human cancer risk from these unrealistic machine measurements and presented the data in way that was bound to mislead, which it duly did and created a world-wide media storm. This was irresponsible science, careless publishing, and credulous journalism adversely changing the perceptions of the relative risks of smoking and vaping in a way that will cause harm. The paper should be retracted in its entirety".
And on and on and on. 'Experts,' media, spouting crap, anything to demonise this perceived threat - and not necessarily a threat to the vaping consumer. Lipoid Pneumonia, Tuberculosis, cancer, gateway,However, thank goodness, there are real experts out there. [Note, no inverted commas].
And now we come to the present day, yesterday in fact. Yesterday I read an article by Sofia Carlsson, Associate Professor, Institute of Environmental Medicine, Karolinska Institute, and Cecilia Magnusson, Professor, Department of Public Health Sciences, Karolinska Institute, here. [You may have to use translate]
They discuss a paper purporting to show a connection between heavy snus use and diabetes type 2. Before saying anything about this, in the above [linked] article they stress, and stress it more than once, that we should not jump to conclusions as there may be confounding factors - how very refreshing...
They also state as a fact: "Smoking is an established risk factor for diabetes, and a new problem in previous studies has been to separate snuff effects from smoking as inter use is common."
This comment started warning bells ringing. So I Googled (five minutes' worth) and the very first thing I came up with was... (page 250)
"Then there are quirky findings. In the Sweden study, researchers also looked at the risks associated with using "snus."... In this study, and in contrast to smoking cigarettes, the use of this nicotine containing product did not significantly increase the risk of diabetes."
Oh aye! But it is the next paragraph I find really interesting.
"The Hopkins' study also had an unexpected finding. Although cigarette smoking was clearly linked to type 2 diabetes, stopping smoking led to higher short term risk. highest in the first three years after cessation with a hazard ratio of 1.9.
The last finding is a head scratcher. A report from the University of Oxford, England, involved 1,919 patients followed over 6 years. Of these subjects, 1,216 were initially free of retinopathy
Hang on a second, what on earth is retinopathy? I am not an expert you see. Right, Google: 'Diabetic retinopathy is a complication of diabetes, caused by high blood sugar levels damaging the back of the eye'
and 22% developed the pathology over the next 6 years. Of the 703 persons with retinopathy at the onset of the study, 29% progressed with 2 scale steps or more... Not smoking had an unfavourable effect on the development or progression of retinopathy.
A head scratcher right enough.
Sofia Carlsson, and Cecilia Magnusson, rightly emphasise that there may be many confounding factors but also state that, they, "have also, insofar as possible, taken into account other risk factors for type 2 diabetes such as overweight, physical inactivity, heredity, alcohol consumption, and education level." Did they? I do not have access to the research and even if I did, I doubt that I would understand much of it. It just seems to me to be an echo of previous, dubious e-cigarette studies. It just seems to me that not enough attention has been paid to the lifestyles of the participants... For example, is it the case that, like so many heavy smokers, heavy snus users are concentrated within specific society groupings, that they tend to be less active: that their diets are poorer; they belong to a particular ethnic group. (Some racial, ethnic groups continue smoking cigarettes at higher rates) Whatever...
It seems dubious to me that just because diabetes is higher in heavy snus users that it is the snus which is the cause? The researchers welcome any discussion - so do I.
And please take into account http://www.accessdata.fda.gov/Static/widgets/tobacco/MRTP/18%20appendix-6a-environ-snus-monograph-2013.pdf
Pay particular attention to the sections dealing with diabetes.... and you say that there has been little research. Hmmm!
But why do so many researchers publish materials that that are so far from the truth? What can it be that motivates them to go down this road? Michael Siegel, Professor in the Department of Community Health Sciences at Boston University School of Public Health gives us an insight into the world of Tobacco Control. He paints a picture of a world where individuals are indoctrinated and controlled. A world which will broke no contradiction; suffer any criticism.
He says, in an article, containing a great deal more...
"...if I conduct a study and it fails to show a significant relationship between second hand smoke and chronic disease, then all of the sudden, I have automatically become an illegitimate scientist."
"If it fails to show." Is this why so many 'studies' risk ridicule; a combination of induced blindness and fear?
"I was able to overcome my "brainwashing," but it took a lot of courage to do so, and a lot of risk to my career. I paid a heavy price for breaking out of the mould into which I had been cast. It shattered my career in tobacco control. But at least it didn't shatter me, and the person who I really am."
How many experts show this kind of courage, and the answer, surprisingly, is quite a few... these are the experts, the genuine ones, and their number is growing.
The edifice which is Tobacco Control is crumbling. Soon it will be gone.
New Nicotine Alliance would like to offer our thanks to Robert Innes for this guest blog entry. He can be reached on Twitter at @brainyfurball