British Government Promotes Cigarettes

The UK will regulate all nicotine-containing products, including e-cigarettes, as medicines, starting in 2016 (here).

The British bureaucrats justified their decision: “Our research has shown that existing electronic cigarettes and other nicotine containing products on the market are not good enough to meet this public health priority [i.e., “reducing the harms of smoking to smokers and those around them”]… Our investigations also found that the amount of nicotine per product differs from batch to batch so this casts doubt on how useful these products are to people who want to cut down or to stop smoking.”

While the government says it is acting “so that people using these products have the confidence that they are safe, are of the right quality and work,” the need for added regulation is questionable.  The government’s own press release confirms the popularity of available e-cigarettes – which could be seen as consumer confidence – noting that “their use has grown rapidly with an estimated 1.3 million people using them in 2013.” 

Clive Bates, former director of Action on Smoking and Health UK, strongly criticized the regulators on his blog:  “They want to substitute their own view of ‘efficacy’ (what works) for the consumers’ view.  Markets work by people buying the good products and the poor products failing, not by regulators deciding what works.”

Bates provides nine other reasons why this decision is a “bad idea”.  His must-read blog is available here.

According to the government release, “Smoking is the biggest single cause of avoidable death - killing 80,000 people in England each year.”  Regulation of e-cigarettes as medicines is likely to limit or eliminate the availability of these popular and far safer smoking alternatives.  Removing them from the marketplace only encourages smokers to continue smoking, making the UK government a culpable enabler of this deadly habit.

E-cigarettes are recreational tobacco products, not medicines.  They should be regulated accordingly.  The only consolation is that there will be five to ten million British e-cigarette users in 2016, a formidable political force that may not tolerate a regulatory barrier to the continued supply of these life-saving products.       

Trace Metals in E-Cigarettes: No Cause for Concern

I have discussed a study reporting that smokeless tobacco contains trace levels of several metals, including cadmium, arsenic, nickel, chromium and lead (here).  Now researchers at the University of California, Riverside, report that the aerosol from an undisclosed e-cigarette contained numerous metals.

The study, whose lead author is Monique Williams, appears in PLoS One (here). It notes, “A total of 22 elements were identified in EC [electronic cigarette] aerosol, and three of these elements (lead, nickel, and chromium) appear on the FDA's ‘harmful and potentially harmful chemicals’ list.  Lead and chromium concentrations in EC aerosols were within the range of conventional cigarettes, while nickel was about 2–100 times higher in concentration in EC aerosol than in Marlboro brand cigarettes.”

The article implies that e-cigarettes are the source of inhaled toxic metals.  But, as pointed out previously by Boston University’s Michael Siegel (here), the amount of metals delivered to e-cigarette users is lower than the daily exposures permitted by the authoritative US Pharmacopeial Convention (USP) for inhalable medications.

Williams and colleagues reported that 10 aerosol puffs, the equivalent of one cigarette, contained 0.017 micrograms (ug, one-millionth of a gram) of lead.  This means that a pack-a-day equivalent (200 puffs) contains 0.34 ug of lead.  According to the USP (here), it is permissible for an inhaled medication to deliver up to 5 ug of lead per day to a 50 kilogram (~ 100 pound) person. 

The same holds true for nickel, chromium and copper.  For nickel, Williams reported the pack-a-day e-cigarette level at 0.1 ug, while the USP allows 1.5 ug per day in inhaled medicines.  For chromium, Williams reported that e-cigarettes deliver 0.14 ug, while the USP allows 25 ug in inhaled medicines.  For copper, the Williams-reported level is 4.06 ug; the USP allows 100 ug.  

Tin is another metal Williams reported in e-cigarette vapor, at 0.74 ug per 200 puffs. The CDC reports (here) that the average U.S. daily intake of tin by inhalation is 3 ug.  

To be clear, the problem with the Williams study is not that it reported trace concentrations of metals in e-cigarette vapor.  That is useful information.  The problem with this study, as with most works of this kind in the past 20 years, is that it was published without context.  As the above quote shows, e-cigarettes were compared to traditional cigarettes without any reference to exposure from other inhalation settings and/or products.  

Such demonization of e-cigarettes is inappropriate, and authors and journal editors share culpability.  Greater effort should be made to avoid bias in reporting of scientific data, particularly when public health is at stake.