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CASAA funded research finds electronic cigarettes pose minimal danger to vapers or bystanders

This week saw the publication of the results (PDF) of an important project which sought to ascertain in as near to absolute terms as possible the safety of electronic cigarette vapor. The results show that the use of e-cigarettes poses minimal risks to those using them and to those exposed to second-hand vapors.

The research itself was funded and conducted in a completely unique way. Consumer association, CASAA, which is run by unpaid volunteer e-cigarette consumers asked for donations from the vaping community so that they could fund an independent scientist to analyze the published research with respect to the specific question of contaminants in e-cigarette vapour.

The amount needed to fund the project was exceeded in under one week, and the project went into action. Igor Burstyn, an associate professor at Drexel University, conducted the research which consisted of a meta-analysis of over 900 published studies into the chemical composition of e-cigarette vapor and liquids. The principal issue Burstyn was faced with (and the reason that this research was so necessary) is that these studies used very different methodologies. So, a large part of what he had to do was to convert the data to a common measure so that the overall picture could be seen clearly.

The measure he used was the Threshold Limit Value (TLV), which is an estimate of toxicity values of given substances, specifically with respect to occupational exposure. In other words, TLVs are chemical levels that are deemed safe for workers who might be exposed to them in the ordinary course of their work. Of course, there are other measures that can be used, and ones which might be more appropriate, but it’s presumably right and proper that the subject matter expert in question should use the measure they are most familiar with. Certain quarters (e.g. Stanton Glantz) have been very quick to dismiss the paper outright, however, on this trivial basis.

But quibbling over which level is most appropriate is to completely obfuscate what Dr. Burstyn’s research has shown. Firstly, it must be noted that overall exposure levels were shown to be less than 5% of the TLVs. Does anyone seriously believe that even using another, more conservative, measure that we would see any indication of increased risk over and above what this study shows?

Additionally, a comment has appeared on Prof. Glantz’ blog by “second-hand smoke consultant”, James Repace. Specifically, he maintains that the formaldehyde levels detected in the research are likely to contribute to 2 cases of cancer in 10,000. What he signally fails to acknowledge (and it’s dealt with thoroughly by Burstyn in the paper), is that the formaldehyde detected by the authors, Schripp et al., was produced by the volunteers themselves. That’s right, small amounts of formaldehyde are produced by every single one of us as part of the normal metabolic process. Perhaps it is true, therefore, that people are themselves carcinogenic. Perhaps we should limit exposure to each other and ensure that we ourselves are constantly ventilated so as not to inhale our own metabolites. If we wish to be completely risk averse, this might be a consideration.

Of course, I’m being facetious, but there is an important point to take from this which is that risk is an inherent part of life. If we try to eliminate risk, we run the danger of creating new risks in the pursuit of absolute safety. And this is precisely what the opponents of electronic cigarettes are doing today.

We now know that risks from electronic cigarettes are minimal. Tinier indeed than many vapers expected. But we also know that the risks from inhaling tobacco smoke are so large that anything that reduces inhaled smoke is greatly risk minimizing, even if it has small attendant risks itself. E-cigarettes are the first product to come on the market, arguably ever, which have any real potential to affect the behavior of those smokers who cannot or will not quit. This is a huge prize and the opponents’ arguments are already weak and becoming increasingly nasty (witness for example, Glantz’ slur against Carl Phillips on his blog).

The mind boggles exactly what these people need to see to be convinced. We now have an excellent meta-analysis published by a well-respected and independent expert with no axe to grind, and the reaction by some in tobacco control is to reflexively dismiss it on the basis of a trivial point relating to the measure used. We’ve seen this before with a study by Caponetti et al, which was a perfectly good study with weaknesses that were fully disclosed by the authors, yet the reaction from certain quarters was to instantly dismiss it on the basis, again, of trivial matters.

Here is another plea to those who I think it’s increasingly obvious are ideologically opposed to electronic cigarettes: Please engage with this powerful and disruptive technology in good faith.

And here’s a warning. If you don’t you’re going to look more and more ridiculous, even within the circles in which you currently have great respect.  

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