The opponents of e-cigarettes have determined that ‘ultrafine particles’ or ‘particulates’ are an issue they can work with. But this campaigning gambit, it turns out, involves a crude scientific sleight of hand. We’ll explore this by looking at some examples and the appropriate responses.
Note: Are you looking at this and thinking ‘that looks a bit long’? If so, Carl Phillips has provided: What is wrong with ecig particulate claims – the simple version. The short version is that e-cig aerosols are have completely different physics (they are liquid droplets) and completely different chemistry (they have hardly any of the toxic properties) to the particulates generated by combustion or pollution processes. So why would anyone expect them to have the same impact on health? But I’d be delighted if you press on…so let’s start with…
The University of California at San Francisco – Professor Stanton Glantz
Professor Stanton Glantz, perhaps the world’s top anti-vaping activist, is the leading advocate of the ‘ultrafine particles’ theory of e-cigarette health risk. In a discussion of e-cigarette science, he asserts for example:
The ultrafine particles that cigarettes (and e-cigarettes) deliver have substantial adverse effects on the cardiovascular system.[4]
Notice the conflation of cigarettes and e-cigarettes in this statement. This, as we shall see, is at the heart of the sleight of hand. Reference 4 and the link (below) are directed to two sources on secondhand tobacco smoke, which have nothing whatever to do with e-cigarettes, even though e-cigarettes is the subject he is actually writing about. Reference 4 is as follows:
[4] Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. 2009. Also see Barnoya J, Glantz S. Cardiovascular effects of secondhand smoke: nearly as large as smoking. Circulation 2005 May 24;111(20):2684-98 and Grana RL, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation 2014 May 13;129(19):1972-86. doi: 10.1161/CIRCULATIONAHA.114.007667.
The third and final citation in this reference his own review of e-cigarettes in Circulation is discussed below. Professor Glantz is duly taken down by Dr Farsalinos in his critique of this assertion. In his posting: Abuse of evidence and argument: a response to Stanton Glantz’ criticisms of an expert letter to WHO on tobacco harm reduction, Farsalinos comments:
However, this is a direct mis-presentation of evidence, since there is not even a single study indicating that particles emitted from e-cigarettes represent a risk factor for cardiovascular disease. The review cited (co-authored by the writer of the critique) is again a mis-presentation of science, making an arbitrary conclusion that the evidence linking environmental pollution or cigarette smoke particles with cardiovascular disease can be applied to e-cigarettes. (original emphasis)
The important and obvious point for scientists and non-scientists alike is that it is not just the size of the particles that matters, but what they are made of. That is how reactive and toxic the surface chemistry is and whether they are liquid and likely to be easily absorbed or solid and likely to lodge in lung tissue. There is a big difference between the soot from diesel engines, emissions from power stations, photochemical smog or biomass burning (including the hot reactive organic particles in tobacco smoke) and the relatively benign components of an e-cigarette vapour droplet. In an act of heroic obfuscation, in their review of e-cigarettes published in Circulation as mentioned above, Glantz and colleagues manage to admit that e-cigarette vapour might be totally different to cigarette smoke and other environmental pollution, and by implication, that the conclusions that follow from assuming they are equivalent are worthless.
E-cigarettes deliver nicotine by creating an aerosol of ultrafine particles. Fine particles can be variable and chemically complex, and the specific components responsible for toxicity and the relative importance of particle size and particle composition are generally not known. Given these uncertainties, it is not clear whether the ultrafine particles delivered by e-cigarettes have health effects and toxicity similar to the ambient fine particles generated by conventional cigarette smoke or secondhand smoke. There is strong evidence, however, that frequent low or short-term levels of exposure to fine and ultrafine particles from tobacco smoke or air pollution can contribute to pulmonary and systemic inflammatory processes and increase the risk of cardiovascular and respiratory disease and death. (emphasis added) – Grana, Benowitz, Glantz, Circulation 2014.
Despite the tortuous formulation aimed at sounding is if it is obvious (but not yet proven) that e-cigarettes and cigarette particles would have the same effect, this paragraph actually acknowledges that the chemical composition of the particle is critical. Translation: e-cigarette vapour bears no relation to cigarette smoke or anything else generally regarded as hazardous in particulate form, but we’ll suggest it is like tobacco smoke all the same.
Update: for a more complete discussion of tobacco smoke physics and chemistry, see Chapter 3 of the Surgeon General 2010 report: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. The SG states the obvious – the chemical composition is at the heart of the toxicology:
Cigarette smoke is a complex mixture of chemical compounds that are bound to aerosol particles or are free in the gas phase. Chemical compounds in tobacco can be distilled into smoke or can react to form other constituents that are then distilled to smoke. Researchers have estimated that cigarette smoke has 7,357 chemical compounds from many different classes (Rodgman and Perfetti 2009). In assessing the nature of tobacco smoke, scientists must consider chemical composition, concentrations of components, particle size, and particle charge (Dube and Green 1982). These characteristics vary with the cigarette design and the chemical nature of the product.
The SG goes further and identifies leading culprits in chemicals present in tobacco smoke…
Fowles and Dybing (2003) suggested an approach to identify the chemical components in tobacco smoke with the greatest potential for toxic effects. They considered the risk for cancer, cardiovascular disease, and heart disease. Using this approach, these investigators found that 1,3-butadiene presented by far the most significant cancer risk; acrolein and acetaldehyde had the greatest potential to be respiratory irritants; and cyanide, arsenic, and the cresols were the primary sources of cardiovascular risk. Other chemical classes of concern include other metals, N-nitrosamines, and polycyclic aromatic hydrocarbons (PAHs). This evaluation, along with the Hoffmann list of biologically active chemicals (Hoffmann and Hoffmann 1998), was used to select the chemicals reviewed in this chapter. Other chemical components with potential for harm will be identified as analysis of tobacco smoke becomes more complete and cigarette design and additives change.
So if and when these compounds, or others with equivalent toxic effects, show up in material quantities in vapour products operated under realistic conditions then we can start to be concerned about whether droplet size makes it worse. But there is no point in starting with droplet size before establishing a toxic risk from the composition.
London School of Hygiene and Tropical Medicine – Professor Martin McKee
Professor Martin McKee, an anti-e-cigarette activist and media commentator, has had a go at bringing Professor Glantz’ arguments into Britain, via the New Scientist. McKee asserts:
… there is increasing evidence that the ultrafine particles released in e-cigarettes may have adverse consequences for the cardiovascular system. For these reasons, a wide range of medical and public health bodies, including the World Health Organization, have expressed serious concern about their promotion.
The problem is that the hyperlink to ‘evidence’ in this in this statement actually provides no evidence. It certainly does not show that ultrafine particles released from e-cigarettes have adverse effects on the cardiovascular system. The authors of the cited article were eventually forced to acknowledge this in subsequent exchanges. The study cited merely discovers the obvious fact that the e-cigarette aerosol contains, well, an aerosol, and that this is counted as particulate matter in measurements. The study in question (Schober et al 2014) does not attempt to make the case that the particulates are harmful, simply that they exist. Also note that in Professor McKee’s world, if enough organisations express concern about something it sort of becomes true, but they are all basically repeating the same flawed argument.
Once again, Dr Farsalinos delivers the punch in a letter to the journal criticising Schober et al. In a write up on his must-read blog Farsalinos summarises the exchange.
For the issue of PM, they [Schober et al] acknowledged that the composition is different, and added that “it cannot be deduced from this, that long-term inhalation of 1,2-propanediol nano-droplets must be completely safe.” Well, in a similar way we can support that there is currently no evidence showing that inhalation of 1,2-propanediol (PG) nano-droplets is unsafe.
In other words, they made no assessment of risk of the e-cigarette aerosol, and so cannot conclude whether there is a risk. So they resorted to the scientific scoundrel’s defensive attack of ‘can’t prove completely safe‘, which is a scientific non sequitur. Note also the use of the chemical term 1,2 propanediol instead of the common name ‘propylene glycol’. Why did Schober et al do that, given the likely wide interest in these findings? Here’s a thought: which is more unfamiliar and dangerous sounding? In fact PG is ‘Generally Accepted as Safe’ for use in foods by the FDA, widely used in cosmetics and in pharmaceuticals as an excipient (see Dow safety information). Schober et al was also subject to a robust critique by Carl Phillips and Igor Burstyn, the latter an expert in occupational hygiene and exposure assessment. That is well worth reading in full, but here is one of the more damning statements from it:
The device the authors used to detect “particles” does not distinguish between droplets and solid particles; to assess any health-relevant particles the authors should have used gravimetric techniques that determine the mass of solid particles emitted into the air. As such, the authors’ work suffers from inadequate testing of their major conclusion and confirmation bias: they assumed health-relevant particles would be present in the aerosol, performed a test that was incapable of ruling that out, and then interpreted their results as confirmation.
129 “public health and medical authorities”
In a letter to WHO Director General Margaret Chan, 129 public health academics and activists signed up to the following statement drafted by Professor Glantz:
There is already good evidence that ENDS emissions release several toxic substances into the environment that cause harm to health. These substances include ultrafine particles […]
Again references to Schober et al are used to justify this statement or they simply note the presence of ‘particulates’ as if that is sufficient to justify the claim that these are harmful to health. In response, scientists who work in this field replied with a strongly critical letter to Dr Chan, calling for “dispassionate interpretation and presentation of evidence”. The fascination with particle size, rather than chemical composition, was briskly dismissed:
Reference is also made to ‘ultrafine particles’ as though it is particle size that governs risk to health. In fact the lowest size particles are water vapor, which carries no health risk. What matters most is the chemical composition of the particulate matter – and this differs completely between tobacco smoke and e-cigarette vapor.
World Health Organisation – Tobacco Free Initiative
Regrettably WHO out-sourced its science to UCSF and has taken its scientific cue from Professor Glantz. It has therefore ended up promoting the ‘particulates theory’ at a global scale, while attempting to draw on WHO’s standing in air quality science in an effort to legitimise its tobacco policy. In its September 2014 paper on ‘Electronic Nicotine Delivery Systems (ENDS)’ for COP-6 WHO suggested that evidence from environmental air quality could be applied to e-cigarette aerosol. The sleight of hand in applying science and evidence that has been developed for one thing (atmospheric air pollution) to something completely different (e-cigarette vapour) is not acknowledged, and its unclear if the authors were even aware that they were doing that. Here is the relevant passage:
15(b). However, epidemiological evidence from environmental studies shows adverse effects of particulate matter from any source following both short-term and long-term exposures. The low end of the range of concentrations at which adverse health effects has been demonstrated is not greatly above the background concentration, which for particles smaller than 2.5 μm has been estimated to be 3–5 μg/m3 and increases with dose, which means that there is no threshold for harm and that public health measures should aim at achieving the lowest concentrations possible [6].
The source [6] given for this statement is WHO air quality guidelines for particulate matter, ozone, nitrogen dioxide and sulfur dioxide: summary of risk assessment. Geneva: World Health Organization; 2006.
However , these guidelines do not in fact apply to any source and this is incorrectly asserted in the WHO ENDS paper. The guidelines are, as any reasonable person would expect, entirely focussed on the type of particulate matter that one might expect to form hazardous air pollutants – diesel exhaust, power stations emissions, biomass combustion and fine particle of dust or degrading road surfaces etc. They give no basis whatsoever to claim that the these conclusions can be generalised to e-cigarette aerosol. WHO’s ENDS paper (not its air quality guidelines) has simply assumed that the evidence from the particles routinely studied for air pollution science can be generalised to e-cigarettes, but it cannot. The WHO air quality guidelines confirm their focus:
[PM10] is primarily produced by mechanical processes such as construction activities, road dust re-suspension and wind, whereas [PM2.5] originates primarily from combustion sources. In most urban environments, both coarse and fine mode particles are present, but the proportion of particles in these two size ranges is likely to vary substantially between cities around the world, depending on local geography, meteorology and specific PM sources. In some areas, the combustion of wood and other biomass fuels can be an important source of particulate air pollution, the resulting combustion particles being largely in the fine (PM2.5) mode.
[Counterfactual note: PM10 means particles less than 1o microns – one hundredth of a millimetre – in diameter. PM2.5 means smaller than 2.5 microns – the particle size affects penetration and pathways into the body]
Unsurprisingly, there is no reference to any epidemiological evidence that relates to e-cigarettes aerosol or to anything remotely similar chemically or physically. Even the epidemiology for different types of products of combustion is limited. However, WHO’s air quality experts are content to conclude that all of these sources of products of combustion can be treated in a similar manner. This is a reasonable judgement in my view, but not one that can be reasonably extended to e-cigarette aerosol particulates, given that are quite different in chemical and physical composition to solid phase products of combustion. To the extent that these guidelines say it is not possible to isolate the impacts of specific pollutants, this is the key paragraph:
Although few epidemiological studies have compared the relative toxicity of the products of fossil fuel and biomass combustion, similar effect estimates are found for a wide range of cities in both developed and developing countries. It is, therefore, reasonable to assume that the health effects of PM2.5 from both of these sources are broadly the same. By the same token, the WHO AQG [air quality guideline] for PM can also be applied to the indoor environment, specifically in the developing world, where large populations are exposed to high levels of combustion particles derived from indoor stoves and fires.
This is all focussed on products of combustion. I respectfully submit that it is an unreasonable leap to conclude that this discussion embraces e-cigarette vapour, which is not a product of combustion at all… and therefore WHO mislead the Conference of the Parties of the FCTC with its support for the ‘particulates theory’.
E-cigarette Summit presentation by particulates specialists – WHO air quality science
The subject of particulate matter from e-cigarettes was raised at the E-cigarette Summit in London (13 November 2014) in the form of a presentation (Chamber study on second hand e-cigarette “smoke” – preliminary results) by two scientists, Professor Gordon McFiggans and Professor Roy Harrison OBE. The presentation started with an account of the health impacts of particulates – showing a very large annual premature death toll of 200,000 for the UK (more than for smoking) and 340,000 years of lost life. This is certainly a troubling health burden (though the figures are strongly contested)…. but is it in any way applicable to e-cigarettes? Nothing in the report suggests it is.
The presentation mentioned that there are four broad categories of particulates:
- Primary mechanical: airborne particles like dust from deserts, degrading road surfaces, pollen etc
- Primary combustion: products of combustion like diesel smoke, power station emissions, and biomass burning – this category would include tobacco smoke
- Secondary: pollutants that form through atmospheric reactions like photochemical smog
- Volatile primary / secondary – things like clouds, spray perfumes and air fresheners – this category would include e-cigarette vapour
They then went on to describe measurements of e-cigarette aerosol in a chamber study, showing that e-cigarettes produced measurable amounts of this 4th class of particulates. However, they did not show that the 4th class of particulate are actually harmful, or that e-cigarettes might be expected to be harmful and contribute to the death toll. And that is rather important… so I put the obvious question, in so many words: isn’t it composition that matters most…? Cigarette smoke particles are solid and lodge in the lungs and have highly reactive surface chemistry with potentially thousands of products of combustion, many of which will be carcinogenic and reactive. This is quite different to vapour aerosol. As Carl Phillips and Igor Burstyn put it in their critique of Schober et al
While droplets are particulates in the broadest sense of the term, in the context of environmental pollution that term generally refers to fine solid particles that can lodge in or be absorbed through the lungs intact. A liquid, of course, just dilutes into the bloodstream or other bodily liquids, regardless of particle size and deposition location. Thus, the extensive discussion of particulate size, let alone the explicit claims about health implications, is highly misleading.
Professor McFiggans was generous enough to give a confident and honest answer, which can be summarised (I paraphrase): of course the composition and toxicity matters. Professor Harrison, however, was undeterred and in his reply referred the audience to the latest “REVIHAAP report” of WHO. He argued that it showed that the epidemiology did not allow us to distinguish between different types of particulate. I thought this was an odd formulation at the time: having insufficient evidence to distinguish between types of air pollutant is not the same as having evidence that they should be treated the same. It turns out the report itself is rather more informative than this.
I decided to look the report up: and discovered this is the Review of evidence on health aspects of air pollution – REVIHAAP project: final technical report. Professor Harrison was an expert reviewer. The key section for our purposes is A2 page 10-31 (PDF extract). A review of this shows there is absolutely no basis for assuming equivalence between e-cigarette aerosol and the environmental particulates in general. A few observations from the report now follow.
Professor Harrison was, I think, basing his response on this conclusion from the report:
The integrated science assessment used evidence from both epidemiological and experimental studies to conclude that “there are many components contributing to the health effects of PM2.5, but not sufficient evidence to differentiate those constituents (or sources) that are more closely related to specific health outcomes” (EPA, 2009). Despite the increased number of studies (especially epidemiological) after 2009, the general conclusion remains the same. (page 12)
It should be obvious, as I hinted above, that this statement does not justify treating e-cigarette aerosol as though it is as harmful as diesel smoke, degrading road surfaces, power station emissions, smog etc. It simply means they don’t have the science to tell the impacts of the different particulate types apart, not that there is evidence that they are uniformly harmful. In fact there is much in the report to reassure e-cigarette users and to justify calling on the various opponents of e-cigarettes to withdraw their claims about e-cigarette ‘particulates’.
In a statement of the obvious, the first section acknowledges that chemical composition is critically important:
Epidemiological and toxicological studies have shown PM mass (PM2.5 and PM10) comprises fractions with varying types and degrees of health effects, suggesting a role for both the chemical composition (such as transition metals and combustion-derived primary and secondary organic particles) and physical properties (size, particle number and surface area) (page 10 – emphasis added)
This makes perfect sense to me: you would be concerned both about a toxic agent and the pathways through which it could expose a human, which may depend on its physical characteristics. But the agent has to be toxic in some way or the manner of exposure isn’t very important. Professor Robert West spoke from the floor and emphasised the point that you would expect there to be something toxic or carcinogenic about the particles before the size starts to become a concern. It is this insight that leads to the reductio ad absurdum case of water droplets (which also count as particulates) to challenge the notion that all particulates are harmful.
The report goes on to discuss particulate source types for which there is evidence of harmful effects (page 11):
B. Source types
A variety of air pollution sources have been associated with different types of health effects. Most of the evidence accumulated so far is for an adverse effect on health of carbonaceous material from traffic (see also Question C1). A more limited number of studies suggest that traffic-generated dust, including road, brake and tyre wear, also contribute to the adverse effects on health.
1. Coal combustion results in sulfate-contaminated particles, for which epidemiological studies show strong evidence of adverse effects on health.
2. Sources of PM emission relevant to health also include shipping (oil combustion) power generation (oil and coal combustion) and the metal industry (such as nickel).
3. Exposure to particles from biomass combustion – most notably residential wood combustion – may be associated not only with respiratory, but also with cardiovascular health.
4. Desert dust episodes have been linked with cardiovascular hospital admissions and mortality in a number of recent epidemiological studies.
E-cigarette aerosol is of course not mentioned, but nor is anything remotely resembling it in chemical or physical form. Note that it is implicit in this section that not all source types are assumed to have health effects simply by virtue of being particulates – why would they try to differentiate between source types otherwise? Most of the discussion in the paper of course relates to the actual particulates that are recognised air pollutants (from traffic etc), and it is these whose effect cannot be isolated from each other (page 12):
The particle constituents most often included in the studies have been sulfate and black carbon […]
In epidemiological studies, the effects of combustion-derived organic carbon are difficult to separate from those of black carbon and/or elemental carbon because of a high correlation due to the common source: combustion processes (WHO Regional Office for Europe, 2012). Elemental carbon is most strongly associated with primary combustion particles and primary organic carbon, whereas secondary organic aerosol formation is delayed with respect the primary emissions, because secondary organic carbon is formed during longer range transport in the atmosphere. Secondary organic carbon also has a significant biological component, but this part of PM has hardly been studied in relation to health effects.
So the discussion here is about evidence that would allow a distinction between several categories that are not relevant to e-cigarette aerosol. The report goes on to express a fair amount of concern about ‘ultrafine particle’ (less than 1/1oth micron = 100nm), but once again this refers to the primary source of these, namely products of combustion (page 17):
There is a general consensus that ultrafine particles are defined as particles smaller than 100 nm in mobility diameter and mostly stem from combustion processes in urban settings (Peters, Rückerl & Cyrys, 2011)
So again we are really talking about products of combustion in traffic, power stations, cooking and heating, and biomass burning. It is simply not legitimate to take research findings about the ultrafine soot and smoke particles and cut and paste those to e-cigarette aerosol, which has completely different chemistry and physical form.
The report does discuss the state of knowledge on particulate source types, reviewing epidemiology, clinical studies and toxicology for the sources under the main headings below (page 21-29):
(b) The role of source types
- Traffic
- Coal and oil combustion
- Industry
- Biomass combustion
- Desert dust
- Ocean and sea
- Hazardous waste sites
No sign of anything here that looks remotely like e-cigarette aerosol. The only one that comes close is oceans and sea. There has been concern about sea salt, though of course there is no sea salt in e-cigarette vapour. However, in the report, the sea salt case establishes a useful precedent for our puposes. These are the conclusions for sea salt (page 29 – please read the document for the full text):
Epidemiological studies. […] All in all, there is little epidemiological evidence of the harmfulness of sea salt.
Clinical studies: […] The study provided clear evidence that PM dominated by sea salt and/or sea spray is far less toxic than equal amounts of combustion-derived PM
Toxicological studies: In no study published since 2005 has the role of sea spray and/or sea salt been investigated, although sea salt is not classified as a hazardous compound and it is plausible that at current exposure levels no harmful effects will occur.
Why dwell on sea salt? Well it shows that not everything that is classed as a particulate is classed as inherently harmful simply by virtue of being a particulate. It shows that other evidence can and should be gathered and that what the particulate is composed of actually matters. And it is not as if we know nothing of e-cigarette vapour – it has been fairly extensively studied, and I make no apology for again citing the 2014 Burstyn review: Peering through the mist: systematic review of what the chemistry of contaminants in electronic cigarettes tells us about health risks:
Current state of knowledge about chemistry of liquids and aerosols associated with electronic cigarettes indicates that there is no evidence that vaping produces inhalable exposures to contaminants of the aerosol that would warrant health concerns by the standards that are used to ensure safety of workplaces. However, the aerosol generated during vaping as a whole (contaminants plus declared ingredients) creates personal exposures that would justify surveillance of health among exposed persons in conjunction with investigation of means to keep any adverse health effects as low as reasonably achievable. Exposures of bystanders are likely to be orders of magnitude less, and thus pose no apparent concern.
This advice is sound: it sees no reason for alarm and no reason for concern about bystanders, but recommends the cautious approach of surveillance to detect adverse health effects in users should they arise.
Is there nothing to worry about?
The advocates of this ‘particulates theory’ should stop simply assuming that e-cigarette vapour, though chemically and physically completely different to air pollution particulates, can be treated as though it poses similar risks to health to diesel exhaust or cigarette smoke. Why not start instead from the insight that e-cigarette aerosol consists mainly of propylene glycol, which is widely used in food and as an excipient in pharmaceutical products, combined with nicotine and flavours?
There are of course risks worth exploring – though these would be dominated by exposure to the user rather than to bystanders. It is possible that flavouring agents could be respiratory sensitisers or have other impacts. It is possible that thermal breakdown products may pose a risk and can be avoided with good design or experience of use. It is possible to manage the levels of contaminant in e-liquids. This is a respectable agenda for regulation and regulatory science – though it should always be conducted with relevant context. That means (a) assessment of risks relative to smoking, and; (b) comparison with acceptable occupational exposure, to assist with benchmarking relative risk. We do not need a research industry making mountains out of molehills and scaring people into continued smoking.
Update: a couple of useful papers.
- Schulte P.A etc al (2010) Occupational exposure limits for nanomaterials: state of the art, J Nanopart Res (2010) 12:1971–1987
- Health Council of the Netherlands (2012) Working with nanoparticles: Exposure registry and health monitoring.
Both suggest that the concerns with ultrafine particle should be carefully differentiated according the physical and chemical characteristics of the particle, not just the size. They state the obvious in other words.
Conclusion
The concern about particulates per se has been manufactured by scientific sleight of hand, through heroic analogy with air pollutants with completely different chemistry and physical form. By frightening people and exaggerating or inventing risks with e-cigarettes, the advocates of this theory encourage continued smoking, make unethical interventions adult informed choice, mislead regulators, protect the cigarette-based business model of the tobacco industry, and prolong the smoking epidemic.
If you work in public health, those are quite bad things to be doing: please cease and desist.
>> All in all, there is little epidemiological evidence of the harmfulness of sea salt.
Are these people in the pay of Big Ocean?
It’s Astrosurf.
Well I think I will invest in an umbrella, just in case.
Nanoparticles are used in many pulmonary route medications http://www.ncbi.nlm.nih.gov/pubmed/17543416.
Do Glantz et al advocate against the use of such meds?
Makes me wonder how much we can believe about smoking too! Anti tobacco ideology has been immoral from the start. Cease and desist? Doubt it. When you were director of ASH, did you ever wonder if anything you promoted (like the TOTAL smoking ban which happened on your watch), was in any way evil? The dodgy science practised now, as then, and promoted by WHO, is perpetrated by people who believe they are RIGHT.
Just a point of fact. I left ASH in April 2003. The English smoking ban came into effect in July 2007. I’m not getting involved in the debate on second hand smoke at this point. I don’t have that much time to spend on these issues, so I’ll stick to doing something useful if I can. I hope you understand.
I do apologise for getting my dates wrong. Should have checked. And I do understand about the SHS issue. I wish someone would question that too – in defense of smokers and the warped fracturing of society that THAT dogy science has caused. Smokers have no Clive Bates. I WAS a smoker, and the pain of the persecution has not left me. There are millions of voiceless people out there, just like me! I will stop feeling angry with you about the total smoking ban that was, to our utter disbelief, passed by an unwitting Parliament, not in OUR name.
I do enjoy your posts, and thank you on behalf of my vaping-self. But my used-to-be-a-smoker-self sees them as an exposure of how corrupt all the Anti Smoking Industries are. If they are doing this to vapers, one can assume the same was/is done to smokers. They have made an anal, terrified and abstinent society on purpose by engineering it so. The world is not better for it!
I was getting worried about Professor Glantz and what years of putting up with San Francisco’s fog might have done to his health. Thanks for setting my mind at rest Clive.
Given that I, as no more than an amateur scientist, can clearly see the difference between the results of 1) walking in a city street for two hours, 2) walking on a beach for two hours, 3) smoking for two hours and 4) vaping for two hours, I would have thought it was only too easy to make a valid comparison. All I need to do is examine my handkerchief afterwards! If that is too graphic for my delicate readers, suffice it to say that activity #1 produces a thick black stain, #3 produces a light brownish stain, and #2 and #4 produce no detectable mark whatsoever. Given that the basic air that I was breathing was of a consistent nature, I deduce that there are fewer particles in cases #2 and #4 than in #1 and #3. I no longer partake of smoking, so I do not worry about potential harm from case #2. But I try to avoid case #1 at any cost, for it seems clear to me, as an amateur scientist,that this is almost certainly the most dangerous activity for the health of my lungs. And yes, I am aware that where I live, in Cornwall, is rich in radioactive radon gas, which is known to be a risk factor in lung cancer.
Most e-cig opponents in the US have the same unscientific, unethical, and inhumane policy about e-cigs as was expressed in a gaffe by Obama’s FDA in April, 2009.
“We don’t want the public to perceive them as a safer alternative to cigarettes.”
http://www.webmd.com/smoking-cessation/features/ecigarettes-under-fire
Since 2009, e-cig opponents in the US (i.e. CTFK, ACS, AHA, ALA, ANR, and many CDC funded state/local health agencies) have lobbied to enact hundreds of laws (to ban vaping everywhere smoking is banned) by deceitfully redefining the word “smoking” to include the use of smokefree e-cigs, and they’ve lobbied for laws that deceitfully rename e-cigs as “electronic smoking devices” or ESDs to confuse the public to believe that e-cigs are just as hazardous as cigarettes.
This is familiar, a few years back these same health authority BS artists, were publicly trumpeting that E-cigs could cause Lipid lung syndrome. The problem with that claim is that e-liquids are; water soluble I.e by definition not Lipids(fats. And it turned out that their entire ‘Lipid Lung’ argument rested upon just one case study, of a German woman who also had serious metal health issues, who was taking a large range of prescription drugs and alternative remedies and was also provably inhaling pesticides.
It is hard to think of a more extreme example of confirmation bias (only seeing the bits that suit you), than that of Stan the man and his mates.
BTW re inhaling salt spray , is there any sort of old time well known occupational condition called ‘sailors lung’, at all?
Nothing I know of…. seafarers are subject to a number of confounders – most notably bloody huge fuel oil combustion emissions from marine engines.
Prior to the steam engine there were hundreds of years when the only power was sail, If salt air was a issue surely there would be cases?
What makes me wonder is if all medicinal procedures are based on voodoo science? And if not how to distinguish the voodoo doctors from the real ones.
I’m just going to leave this here..
This is what happened when I asked Martin McKee about UFP theory a couple of months ago, my question:
You say that the effects of ultra fine particles in the vapour is of particular concern, and that they are found at similar levels in conventional cigarettes and cite Zhang et al 2013. I’ve seen this concern raised before by Prof Glantz and Esteve Fernández at the ICO-WHO conference in Barcelona. What I haven’t yet seen is an explanation of why it is of concern. Now, I’m not a scientist so maybe I’m looking at this too simplistically but surely the composition of the particles is relevant? I can see how the size would affect the penetration / distribution of the particles, but if the particles themselves are benign then what would the harm be?
His response:
Make of that what you will..
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Oh my god, thanks for sharing this – it’s nuts, bananas and fruitcake all at once. McKee really should not be advising anyone, anywhere on anything… I hope he is planning to retire soon.
So to make his case, he cites:
1. The Philippines FDA – which has been tragically mislead or deluded itself into promoting the particulates theory and pseudo science peddled by Glantz, McKee and WHO’s bureaucrats. Fanatics in the Philippines authorities are now considering banning e-cigarettes, and much harm will be the result. This is a travesty to be horrified by, not something to cite approvingly. Own goal!
2. Something about oxidation from air pollution. Yes, some air pollutants have strongly oxidising surface chemistry, and this can be hazardous. That’s the point – the chemical characteristics of the particles is the most important thing. and e-cig aerosol isn’t like products of combustion such as diesel exhaust or cigarette smoke. Own goal!
3. A casual cut ‘n’ paste from the general ambient air pollution literature on inflammation – “whether residency in cities with high air pollution is associated with neuroinflammation/neurodegeneration” – to the specific case of e-cigs for which there is no justification. Own goal!
4. Something about indoor air pollution from cooking, which again involves oxidising products of combustion. Er, not relevant. Own goal!
He says ‘we need to know long term exposure is safe’. Why it’s any business of his is not stated, but we don’t need to answer this scientific ‘proof of safety’ non-sequitur he establishes. Anyone proposing a responsible policy actually needs to know:
– that e-cigs are substantially less risky than smoking, and a viable alternative – there was good consensus at the E-cig Summit that “at least 95% less hazardous than smoking” was a good expert judgement.
– any residual risk is likely to be comparable to that routinely tolerated in society – eg. with reference to occupational exposure limits… Burtsyn’s review gives us plenty of confidence in that.
– that we understand adverse health impacts as they emerge through surveillance – surveillance so far shows likely substantial benefits from smoking cessation and few adverse reactions, and that use is overwhelming concentrated in smokers. If bad things emerge, people can stop using the products or regulators can intervene.
– that we give people clear information on risks so that they can act in their own interests – rather than confusing them and spreading fear, which may have counterproductive consequences such as continued smoking. Martin McKee’s main contribution to that could be a permanent vow of silence, as he is doing the opposite.
He then fudges and fudges again – saying he’s only raising UFP because we just don’t know and that he’s unconvinced and then evasively introduces the ‘overall picture’ – a sure sign he has nothing useful to say on the specifics. So what if he’s unconvinced? He can lock the door to the ivory tower and stay safe, and let real people get on with real-world public health.
Instead he offers you a whole catalogue of propaganda, obfuscation and fake concern for health. The only truthful thing he says in all of this is: “My point is not that we know that these things are harmful“. In his New Scientist piece and other statements he has made, he is not actually saying that “it is that we do not know they are safe“, he is stating that there is evidence that e-cigarettes cause harm or more specifically cardiovascular disease – something that is untrue and even acknowledged in his email.
Perhaps the reality is that Professor McKee is not primarily involved in public health at all, but is an anti-capitalist activist working on the premise that businesses are predatory and consumers are prey. His self-appointed role is to protect helpless citizens like you from being ravished by uncaring capitalism and its poisonous products and evil marketing. This might be why he feels able to patronise you with such a condescending and vacuous reply – you need to know your place and take some instruction from a learned professor who is seeing The Big Picture.
Having seen the anti capitalist / ‘NGO’s and TC are all unpaid martyrs to the cause’ tripe spouted at the recent seminar chaired by McKee and Richard Horton I would say that your last paragraph is spot on. That seminar was an hour and a half long and smokers were not mentioned once. It was entirely geared towards the destruction of the tobacco industry and sprinkled liberally with warnings that no matter what that industry did in terms of harm reduction, it’s all a con and complete victory must be secured at all costs.
Really, all I wanted was a straight answer to what I thought was a straight question – I’ve asked other proponents of UFP theory the same question and received similar meandering replies, as did you when you asked it at the summit. How long will it take them to give this one up as a lame donkey?
Another excellent post Clive. Thanks.
If particulate size alone was a critical factor I’m surprised more hasn’t been made of the following: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874882/ .
Seems to me that using a shower is (potentially) more of a health risk than vaping but don’t recall anyone highlighting this. Kind of underlines their motives l think.
Phil
Absolutely. Given the scale and frequency of exposure, IF particle size alone was enough, we would would have data on the health risks associated with showering. Yet there is (as far as I am aware) no proposed correlation between showering (vs other washing methods, such as bathing) and any kind of health risk at all.
So to simplify, either they are trying to assert:
Breathing fog on Bodmin Moor is just as bad as the smog in Mexico,
Or
My god you’re breathing that stuff in, and it looks funny, so I don’t like it.
Clive,
sorry to go slightly off topic but l remember you writing total abstinence (from nicotine) may not be the best health outcome for some people and have seen similar statements attributed to Riccardo Palosa. Do you have any links that would allow me to learn more about the reasoning behind this?
Phil
Dear Phil
Strictly speaking this is something you could research yourself by typing ‘health benefits of nicotine’ into a search engine. However, I can recommend my friend Jacques Le Houezec on this subject: The positive effects of nicotine.
I was actually making a different point about wellbeing rather than health. People like using nicotine and can feel physiological withdrawal or psychological loss if they give it up. It may be that they would not miss it if they’d never had it, but that’s not where e-cig users are coming from. It is also possible that completely abstinent people may also be more likely to relapse to smoking. So, just in the same way I don’t want to stop drinking coffee in the morning or having a glass of wine with my dinner, I expect there are many people who would have lower wellbeing if they gave up nicotine completely. Robert West tells me few people regret giving up smoking, but that doesn’t mean their optimum state is to give up smoking and nicotine, if they can give up the former and not the latter.
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I was about to add Anti-THR Lies etc. but too late. I spent the morning delaying my dentist with ecig education, afternoon with a consultant and medical student doing the same. I wish I could run a workshop for my local hospital trust but have no idea who to contact as I didn’t have the time for ECCA committee, left, and can’t afford conferences or summits on my pension.
clive
As you know, the previous issue of New Scientist carried a balenced piece on E-cigs. The article contained a important statement
“A recent study comparing the overall harmfulness of cigarettes and e-cigarettes, carried out by the UK’s Independent Scientific Committee on Drugs, gave cigarettes a score of 99.6 out of 100. E-cigarettes scored just 4..” In other words e-vapor is qualitatively very different to cigarette smoke, no comparison.
If Mr McKee was a honest man he would have responded to- attempted to refute that statement directly, but he did not even try. Rather he set out to deliberately redefine the word e-vapor, as meaning the same as cigarette and diesel smoke. Pure Bullshit:
” Someone who lies and someone who tells the truth are playing on opposite sides, so to speak, in the same game. Each responds to the facts as he understands them, although the response of the one is guided by the authority of the truth, while the response of the other defies that authority and refuses to meet its demands. The bullshitter ignores these
demands altogether. He does not reject the authority of the truth,as the liar does, and oppose himself to it. He pays no attention to it at all. By virtue of this, bullshit is a greater enemy of the truth than lies are.”
Harry Frankfurt “On Bullshit”
To give a sense of proportion, the Independent Scientific Committee on Drugs uses a system that rates drugs as to their harm to users and the harm to the community (slightly weighted to harm to user) the committee’s results places : ” heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places.”
In contrast that same committee rates ecigs as a “4”.
Sorry to bang on :-)
The Independent Scientific Committee on Drugs already very low rating of the harmfulness of ecigs is provably a ‘worse case’ rating; just under half of their total points score for any drugs harmfulness is based on that drugs community effects I.e black markets, crime , money being spent on a drug rather than being spent on ‘child care’ and the like. Seems a bit unlikely that ecigs are much of a concern in that area – well apart from the costs of constantly fending off the BS :-(
BTW
I can not find any other drug that has a rating as low as 4; for example ecstasy, which in itself is a very low toxicity drug, is rated as a “9”.
Clive
Have You read this ?http://antithrlies.com/2014/11/18/what-is-wrong-with-ecig-particulate-claims-the-simple-version/#comments
Occam’s razor favors this explanation of why they keep on spouting implausible non-science and nonsense; The likes of McKee and Stana are poorly schooled in theory of science, its methods and above all the thinking skills needed to make a good scientist, as apposed to a technocrat( if even that).
All they have ever read is journals in their own narrow field ,that (often) publish papers that have not been properly checked and written by people who are as poorly’narrowly trained as they are.
Sorry the article What is peer review really? (part 5) is here
http://antithrlies.com/2014/10/29/what-is-peer-review-really-part-5/
I cannot thank you enough. By you, I mean yourself, Carl Phillips, Sarah for her comment and your response. Up until very recently I would have been taken in completely by the arguments presented by people like McKee. Now, I am not, but on reading the above, and comments generated, I realise that I have so much more to learn.
I think that it would be safe to say that I am one of a large number of people fighting to stop over regulation of e cigarettes but who have little or no scientific training. In fact we probably have little training in anything at all outwith normal day to day survival.
In a sense, we are like – and sometimes feel like – an army who, instead of sporting broadswords and wearing shining armour, are dressed in rags and fight with dustbin lids and pitchforks. Give us swords and we would cut ourselves.
This is where you and the others come in.
We can be trained and marshalled – we can be educated and disciplined. It may be, in time, we can wield a sword. However at the moment I rely on you and the others to continue to provide the guidance (however incomplete my understanding) that I need so badly. ( Note how I conflate I and we) Once again, thank you.
Great pic Clive; are they rollin’ coal over in UK now?
The following is a good ‘Meta’ read on the subject of BS in public life (if a tad despairing ) http://clubtroppo.com.au/2014/11/19/complexity-reducability-integrity-and-bullshit-the-general-untheory/#more-26615
‘…Imagine you’re a journalist who has to cover a story on red tape and regulation. Or a politician who has to have something to say on it – or a bureaucrat who has to come up with a policy on it. What are you going to do? You can’t just sit there and say “I don’t really know”, or “nobody knows more than a tiny part of the puzzle”. Deloitte will be putting its finger I the air and estimating the cost of regulation to the whole economy ($250 billion p.a. since you ask). Why saving just 10 per cent of it would be a huge micro-economic reform. What are you going to say? (Quick, you’re on Insiders on Saturday, cameras will be rolling. Remember, John Kerrin got sacked when journalists asked when the early 90s recession would end and he said “Your guess is as good as mine”).
Well there’s only one way through. As the philosopher Henry Frankfurter puts it in his essay:
Bullshit is unavoidable whenever circumstances require someone to talk without knowing what he is talking about. Thus the production of bullshit is stimulated whenever a person’s obligations or opportunities to speak about some topic are more excessive than his knowledge of the facts that are relevant to that topic. This discrepancy is common in public life, where people are frequently impelled, whether by their own propensities or by the demands of others, to speak extensively about matters of which they are to some degree ignorant. Closely related instances arise from the widespread conviction that it is the responsibility of a citizen in a democracy to have opinions about everything, or at least everything that pertains to the conduct of his country’s affairs. The lack of any significant connection between a person’s opinions and his apprehension of reality will be even more severe, needless to say, for someone who believes it his responsibility, as a conscientious moral agent, to evaluate events and conditions in all parts of the world.
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Meet Big Vaping, just like the old boss. What suckers you all are.
Vaping is great!
Vaping is one of the most positive developments in public health this century. Science is firmly on the side of vaping. Unlike cigarette smoke, vape-smoke has been proven to be benign – just water vapour, trace amounts of generally-harmless nicotine additives, glycerine and some other food additives. Unlike cigarettes, as a non-addictive substance, vape-juice is a serious medicinal product, designed primarily to save lives by helping people quit smoking. Millions of lives have already been saved by vaping. Unlike the discredited Big Tobacco companies, vaping products companies tend to be small independents, ran by public-spirited, ethically-minded people. And the best thing is, vape smoke is harmless – it may even assist in treating some colds and flus! There is no scientific or rational justification for subjecting the vaping community to the apartheid treatment meted out to cigarette smokers; and any attempt to do so stems from outdated prejudice and sheer ignorance.
The above paragraph is (of course) unmitigated balderdash.
The above paragraph is a reasonable synopsis of the pernicious, persuasive propaganda that has been (very skilfully) propagated by Big Vaping-Tobacco companies (as we’ll see, in 2018, the two are largely indistinguishable). It has found receptive ears on a lightly-engaged and complacent non-smoking public, on some gullible public health officials; and, naturally, it has been lapped up uncritically and enthusiastically (even zealously) by smokers and new vapers alike.
How Big Vaping-Tobacco plays you
As Brownell & Warner noted, from 1954:
“The tobacco industry had a playbook, a script, that emphasized personal responsibility, paying scientists who delivered research that instilled doubt, criticizing the “junk” science that found harms associated with smoking, making self-regulatory pledges, lobbying with massive resources to stifle government action, introducing “safer” products, and simultaneously manipulating and denying both the addictive nature of their products and their marketing to children.”
Big Vaping-Tobacco is not doing anything original in 2018 – all the old cigarette propaganda tricks are being dusted down and re-used to push vaping. And they’ve been pretty successful – for instance, serious people, including broadsheet journalists and medical people, unthinkingly now parrot the line about vaping being “95% safer” than cigarettes. Public “Health” England trumpeted the good news on its website:
“E-cigarettes around 95% less harmful than tobacco estimates landmark review”
There are two major problems with this conclusion:
The first problem is that it’s being spun into something it isn’t. “Safer” is not the same as “safe”. Cigarette smoke is one of the most toxic concoctions ever devised by humankind. Being “safer” than cigarettes also means that you’re still toxic. Eating 37 Big Macs a day is a lot “less harmful” than eating, say, rat poison, but you really shouldn’t be doing either.
The second problem is that the so-called “landmark study” was hogwash. Its methods and conclusions were flawed and the people carrying it out were deeply conflicted, if not blatantly corrupt. The Lancet (a British weekly peer-reviewed general medical journal and one of the world’s oldest and most reputable medical journals) pulled no punches in its rubbishing of the “landmark study”:
“First, there was a “lack of hard evidence for the harms of most products on most of the criteria”. Second, “there was no formal criterion for the recruitment of the experts”. In other words, the opinions of a small group of individuals with no prespecified expertise in tobacco control were based on an almost total absence of evidence of harm. It is on this extraordinarily flimsy foundation that PHE based the major conclusion and message of its report. The study led by Nutt was funded by Euroswiss Health and Lega Italiana Anti Fumo (LIAF). Riccardo Polosa, one of the authors of the Nutt paper, is the Chief Scientific Advisor to LIAF. In the paper, he reports serving as a consultant to Arbi Group Srl, an e-cigarette distributor. His research on e-cigarettes is currently supported by LIAF. Another author reports serving as a consultant to manufacturers of smoking cessation products.
… the reliance by PHE on work that the authors themselves accept is methodologically weak, and which is made all the more perilous by the declared conflicts of interest surrounding its funding, raises serious questions not only about the conclusions of the PHE report, but also about the quality of the agency’s peer review process. PHE claims that it protects and improves the nation’s health and wellbeing. To do so, it needs to rely on the highest quality evidence. On this occasion, it has fallen short of its mission.”
“Paying scientists who delivered research that instilled doubt” – sounds familiar, doesn’t it? Naturally, The Lancet’s take down of Public “Health” England’s drivel was largely ignored; and the “95% safer” lie runs un-checked to this day.
And it gets worse. On occasion, Big Vaping-Tobacco doesn’t even attempt to cover its tracks – it sends its own scientists out to do the “independent research” and to come up with the “independent conclusions”. Check out this weak-minded clown:
Jimmy Haffey is a self-described “lover, blogger, vaper and ex-smoker [and full-time douche-bag ]” who tells us he’s been “blogging about and supporting Vaping since 2009. They changed my life and I think history will show them as one of the most significant public health invention of the 21st century.”
Good man Jimmy. Anyway, Jimmy (at the link in footnote 5) reported excitedly on another independent scientific study, reported in the Regulatory Toxicology and Pharmacology journal – Jimmy noted that:
“ … researchers were shocked to see that the toxins in ecigarette vapor were quite similar to the normal toxins found in regular room air. This study makes it clear that ecigs are a far better alternative for smokers. They are now scientifically proven to have harm reduction properties and there is no way that lawmakers can argue that public vaping is harmful after looking at these lab reports. The next time you hear someone complaining that public vaping is dangerous, point them to this study. Science is our number one weapon to stop critics and spread truth about all the incredible benefits of vaping.”
Poor old Jimmy and his “incredible benefits” – believes what he needs to believe, of course. Had he been even a little bit less blinded by his own addictions, he’d have perhaps noticed the provenance of the two “researchers”, Rana Tayyarah and Gerald A. Long – at the relevant time, both were employed by a Big Vaping-Tobacco company, Lorillard – check out their accreditations here (click on their names at the top of the article).
Rana Tayyarah
[email protected]
Lorillard Tobacco Company, PO Box 21688, Greensboro, NC, USA
Gerald A. Long
Lorillard Tobacco Company, PO Box 21688, Greensboro, NC, USA
As you’d expect from Big Vaping-Tobacco, in 2012, Lorillard Tobacco Company acquired blu eCigs, one of the more popular e-cigarette companies in the industry, for $135 million (blu eCigs has since become the property of Imperial Brands, a British-based tobacco conglomerate, as a result of various mergers).
So much for “research”. So much for “independence”. So much for poor old Jimmy’s “incredible benefits”.
Incidentally, Lorillard was one of four Big Tobacco companies ordered by a federal court to run a series of public advertisements wherein they admitted that, among other admissions, they had lied to the public and had deliberately tampered with cigarettes to make them even more addictive.
However, they assure us that all that lying is now behind them:
“… in written statements, Altria, which owns Philip Morris, and Reynolds American, which owns R.J. Reynolds and bought Lorillard in 2015 and merged the two companies, say the industry has changed and is now better regulated and more responsible. “We’re focused on the future,” said Altria’s executive vice president Murray Garnick in the statement. The company, he says, is “working to develop less risky tobacco products.”
Less risky products? Such as e-cigarettes? The industry has changed and is now better regulated and more responsible? Ignoring the fact that vaping is largely un-regulated, given Big Tobacco’s despicable track record of a century of cynical, systematic, strategic, well-funded outright lying, it’d take a special kind of moron to believe that that particular Big Vaping-Tobacco leopard has changed a single one of its many spots.
Good to know the future of public health is in such safe hands.
Just because it is written down does not indicate truth. here is some truths
The tobacco companies must come up with new innovative ways to keep people addicted – e-cigarettes meets this criteria (amongst others – third world marketing and distribution comes to mind).
Nicotine is a Poison – does not matter how it is delivered
Nicotine is highly addictive – who knew!
e-cigarettes do not help stop smoking, individuals give up dispite them, all they really do is prolong the activity.
Oh John.
“Nicotine is a Poison – does not matter how it is delivered” = not true, nicotine is not a poison. When dilute, like in aubergine/eggplant (and other Solanaceae) it will not kill you or cause you to feel ill. Same goes for vaping.
“Nicotine is highly addictive – who knew!” – it’s not as addictive as you think. Check out MAOI and nicotine.
“e-cigarettes do not help stop smoking, individuals give up dispite them, all they really do is prolong the activity.” – I have not smoked anything for 5 years since first switching to vaping. My wife (who was a very enthusiastic smoker) finally switched to vaping two weeks ago and it was not easy for her. Easier than quitting though. She is delighted and I am too. No amount of nonsense posted by uninformed people on the internet will take that away, or the fact that she will now be experiencing significantly less harm than smoking. (at least 95%)
While you’re here, try reading some of the articles Clive has posted.
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