Public health authorities are engaging in a worldwide campaign to restrict or even ban the free market of electronic cigarettes. In view of the obvious benefits these alternative nicotine delivery systems provide to smokers, this objective may appear irrational and in conflict with the WHO Framework Convention on Tobacco Control (FCTC). However, the noble ambition of tobacco harm reduction is opposed by financial interests of the tobacco and pharmaceutical industries as well as finance ministers, who all consider electronic cigarettes as a serious threat to their future wealth.
Besides these solid and comprehensible financial issues, the ideologically motivated aim to eradicate everything that might resemble a cigarette and could re-normalize smoking behavior plays a pivotal role. Regardless of their motivation, to justify restrictive regulations, health authorities need arguments to convince politicians and the public of the alleged hazards of electronic cigarettes. As always, pseudoscience comes into play when scientific arguments are lacking. In this post, I will first describe some characteristic features of pseudosciences and then reveal the pseudoscientific background of the anti-ecig campaign.
How to recognize pseudoscience?
This is a photograph of my youngest son, Bernhard, rushing through our living room with his Bobby-Car. As you can see, his activity resembles real driving in many aspects: he is sitting on a car with 4 wheels, he is navigating with a steering wheel, the car has a licence plate, and (what you cannot see) he is even making proper noise. Obviously, Bernhard doesn’t drive (he has no licence yet) but is pretending to drive. Similarly, pseudosciences pretend to be scientific without meeting established criteria. In fact, the issue is more complicated, but this simple definition should suffice here.
The motivations to hail pseudoscientific disciplines are manifold, including lack of education, search for mystery, rejection of realism or reductionism and irrational anti-scientific attitude. In addition, pseudoscience is often used as a means to squeeze money out of gullible people by selling them bogus products or ineffective magic healings, and it may also serve the dissemination of political and ideological concepts. Pseudoscience, that is driven by financial, political, ideological, or otherwise unscientific motives is often referred to as junk science. Following is a list of some characteristic features of pseudoscientific disciplines:
→ political, ideological or religious motivation
→ proposing unfalsifiable hypotheses (hypotheses that are “not even wrong”)
examples: intelligent design, undetectable fields or vibrations (e.g. earth rays)
→ vague and ambiguous language
examples: predictions of fortune tellers, horoscopes, quack medicine (self-healing forces, unhealthy frequencies, remedies acting subtly on the basis of vibrations, etc.)
→ misuse of scientific terms (e.g. energy, information, quantum entanglement)
example: entanglement of patient, practitioner, and remedy in “quantum homeopathy”
→ selective reference to seemingly supporting studies
→ ignorance of contradictory evidence
→ reference to outdated results
→ requesting others to refute a claim (reversal of the burden of proof)
→ claiming that (as yet undetected) effects will be detected in the future
→ misinterpretation of studies and citation out of context
Browsing through this (incomplete) list, you may recognize several tricks used by public health-advocates to discredit electronic cigarettes. Unfortunately, the media tend to accept and spread the misleading information provided by ideologically biased health experts without scrutiny. Below you find a selection of assertions, sorted according to pseudoscientific categories. Claims fitting in more than one category are listed where most appropriate. Most of the claims have been debunked previously by others, so I refrain from repeating the same arguments and provide links for further information instead.
Reversal of the burden of proof
The safety of electronic cigarettes has not been proven.
This statement is an eternal truth applicable to everything and, therefore, meaningless. As I have pointed out in my previous post “Electronic cigarettes and the Loch Ness Monster,” one cannot prove the absence of harm. Electronic cigarettes have to be considered as being safe as long as there is no evidence for harm.
Warnings from effects that could occur (but were not observed yet)
Hazardous ingredients could be detected in e-liquids.
One of my favorites! As I wrote in a recent contribution to a German forum, everything including tiny pink elephants “could be” detected in e-liquids.
Chemicals approved as food flavorings could be harmful if inhaled.
There is no evidence for harmful effects of inhaled flavorings and no reason to believe that. The claim that the inhalation of flavorings is beneficial for airway function (or whatever) is equally valid.
Passive vaping could be harmful.
The argument that the exhaled vapor “could be” harmful to third parties is equally valid as the opposite statement, i.e. that the vapor “could be” beneficial.
Children could be attracted by the fruity appearance of e-liquid bottles.
Possibly correct, but nobody argues against the obligation to protect children from misuse of nicotine containing products (as well as from the misuse of alcoholic beverages, toilet cleaners, knives, matches and many other potentially dangerous products of daily life).
Reliance on refuted or outdated results
Electronic cigarettes are a gateway to tobacco smoking, undermining reduction of smoking prevalence.
Health-advocates consistently misinterpret published surveys and ignore data refuting this assertion.
For more information see, for instance: http://tobaccoanalysis.blogspot.co.at/2014/06/gateway-hypothesis-for-electronic.html
Cancerogenic nitrosamines have been detected in e-liquids.
This assertion is based on the detection of trace amounts of tobacco-specific nitrosamines in some liquids. However, it is deliberately swept under the carpet that foodstuffs contain much higher amounts of nitrosamines and that later analyses of e-liquids were all negative. In the course of recent toxicological evaluations of e-liquids, I have seen certified analyses of dozens of liquids, none of which contained detectable amounts of nitrosamines.
For more information see: http://www.ecigarette-research.com/web/index.php/2013-04-07-09-50-07/120-e-cigs-nitrosamines
Selective reference to supporting data and ignorance of contradictory evidence
Nicotine is a highly addictive drug.
There is overwhelming evidence showing that tobacco addiction is caused by the combined effect of nicotine and other ingredients of tobacco smoke, in particular monoamine oxidase inhibitors. In the absence of tobacco, nicotine does not induce addiction. Smokers switching to electronic cigarettes may remain dependent on the inhalation of nicotine, but it is unclear whether this is due to the perpetuation of drug addiction or reflects dependence on other rewards such as airway sensation (throat hit) or behavioral habits (hand-to-mouth movement, exhalation of vapor). Regardless, nicotine is certainly not a highly addictive drug.
For more information see: http://www.formindep.org/The-myth-of-nicotine-addiction.html#myth
Nicotine is highly toxic. Swallowing of 50 mg of nicotine will kill an adult.
In the post “Electronic cigarettes and nicotine poisoning“, I have pointed out that neither the consumption nor the handling of e-liquids is associated with a significant health risk. As I have described in a recent publication, the famous lethal dose of 50 mg has been suggested more than 100 years ago on the basis of highly dubious self-experiments performed in the mid of the 19th century. Documented cases of nicotine poisoning suggest that the true lethal dose is at least 0.5-1.0 g.
For more information see: http://link.springer.com/article/10.1007%2Fs00204-013-1127-0
Deliberate misinterpretation of studies
Letters of Dr. Stanton Glantz to the FDA
A particularly illustrating example is a comment Dr. Stanton Glantz submitted to the FDA, in which he emphasizes the cardiovascular risk of nicotine consumption. To justify the heading “Nicotine Presents Significant Cardiovascular Health Risks”, Glantz refers to a recently published meta-analysis, in which the authors arrived at the following conclusion (http://www.ncbi.nlm.nih.gov/pubmed/24323793):
“When we examined major adverse cardiovascular events, we found a protective effect with bupropion (RR, 0.45; 95% CI, 0.21–0.85) and no clear evidence of harm with varenicline (RR, 1.34; 95% CI, 0.66–2.66) or nicotine replacement therapy (RR, 1.95; 95% CI, 0.26–4.30).”
Thus, Glantz blithely converts “no clear evidence of harm” to “significant cardiovascular health risks.”
In response to a statement of 53 scientists supporting electronic cigarettes, Dr. Glantz sent a similarly biased open letter to the FDA , in which – strange enough – the involvement of the tobacco industry appears to be a key argument against electronic cigarettes. Note that the Glantz letter was not signed by scientists but by “public health and medical authorities.” It is interesting to compare the evidence-based letter, signed by renowned scientists with documented research expertise in the nicotine field, with the ideology-based pseudoscientific document signed by health authorities and self-proclaimed experts, most of whom are not active in research and lack scientific reputation.
For more information see: http://antithrlies.com/2014/06/12/pruen-v-glantz-v-bates/
Propylene glycol causes airway irritation.
Mantra-like repetition of this assertion doesn’t make it true. The claim is based on a study reporting a small increase in airway resistance upon inhalation of vapor from liquids containing propylene glycol (PG) and nicotine. The key problem of this study is the lack of proper controls. Instead of comparing inhalation of PG with and without nicotine, the authors compared the inhalation of PG + nicotine with breathing air and then blamed PG for causing the effect. Nicotine is well known to cause moderate bronchoconstriction and airway sensation (“throat hit”), a benign effect that may contribute to tobacco addiction. Thus, the study provides no evidence at all for an airway irritating effect of PG, but health-advocates doggedly adhere to this unjustified assertion.
Study published in Chest: http://www.ncbi.nlm.nih.gov/pubmed/22194587
Effects of nicotine on the airways: http://www.ncbi.nlm.nih.gov/pubmed/17137814
Reward from airway sensation: http://www.ncbi.nlm.nih.gov/pubmed/15996724
The ingredients of e-liquids are unknown.
This assertion is too silly to warrant discussion.
Electronic cigarettes are tobacco products because they contain nicotine purified from tobacco plants.
Isolation of a chemical from a certain source does not necessarily implicate identical classification of source and product. Virtually all synthetic organic chemicals, including drugs and food flavorings, are synthesized from starting materials obtained from mineral oil. Though, nobody would declare aspirin or flavored ice cream as petroleum products, I suppose.
Electronic cigarettes may re-normalize smoking behavior.
This is a frequently raised argument against marketing of electronic cigarettes. To account for the undisputed health risks of inhaled tobacco smoke, WHO, CDC and other health organizations have been waging war against smoking for decades. And suddenly a new product appears on the market, use of which looks as smoking in terms of hand-to-mouth movements and production of “smoke.” Now the health-advocates are desperately encountering smoking-like behavior that is not associated with the health risk of real smoking. Instead of praising the obvious benefits, they continue the battle, overlooking that the original enemy has been replaced by a friendly companion.
Health organizations are trying to distract the public from their true ideological aim by stressing over and over again the allegedly high toxicity and addictive properties of nicotine. If this were the true concern, inhalation of nicotine-free liquids should be welcomed. Instead, health-advocates are moving on to – non-existing – risks associated with the inhalation of propylene glycol, glycerol or flavorings contained in e-liquids. The fact that even inhalative medical products (including nicotine sprays approved by the FDA for smoking cessation therapy) contain propylene glycol is generously ignored. Glycerol is a benign endogenous compound, and there is no reason to believe that flavorings used for cooking become dangerous toxins if inhaled.
Thus, the concern about public health is used as an excuse to hide political ideology. Similar to religious wars, the campaign against electronic cigarettes is irrational and inherently anti-scientific. Health authorities judge behavior that is doing no harm as politically undesirable, a distressing interference with fundamental human right, in my opinion.
For further information and references you may consult the following blogs and the links provided therein:
Clive Bates: http://www.clivebates.com
Konstantinos Farsalinos: http://www.ecigarette-research.com/web/index.php
Bill Godshall: http://www.ecigarette-politics.com/bill-godshall-thr-updates.html
Carl V. Phillips: http://antithrlies.com/about-cvphillips/
Michael Siegel: http://tobaccoanalysis.blogspot.co.at
ecigarette reviewed: http://ecigarettereviewed.com
Flickr Creative Commons Image via Arallyn!