Doctors in bitter divide about e-cigarettes

Are e-cigarettes giving tobacco companies the means to appear benign while actually “killing people softly” or are the alternatives offering the best chance of reducing harm from cigarette smoking? Doctors are bitterly divided over the question.

An article in The BMJ reports from both sides of the debate. Simon Capewell, professor of public health and policy at the Institute of Psychology, Health and Society at the UK’s University of Liverpool, tells the journal he is suspicious of big tobacco.

Prof. Capewell argues that if the big tobacco companies were genuinely concerned about the disease and the harm they caused, “they would cease production – end of discussion. They would go into e cigarette production 100%.”

Instead, tobacco companies are cynically acting to worm their ways into public bodies, pretending to be part of the solution and deflecting attention away from the harm they do, argue such public health experts.

The argument against e-cigarettes also says they help to glamorize and renormalize smoking. But such an idea is given a strongly-worded dismissal by one organization that has previously been an arch-enemy of the tobacco companies but now appears alongside them at conferences.

Deborah Arnott, chief executive of the UK charity Action on Smoking and Health (ASH), says:
“There are people in the public health community who are obsessed by e-cigarettes. This idea that it renormalizes smoking is absolute bullshit. There is no evidence so far that it is a gateway into smoking for young people.”

Arnott asks: “Do you want the tobacco industry to carry on making cigarettes which are highly addictive and kill when used as intended, or do you want them to move to a product which is much nearer licensed nicotine replacement therapy and is unlikely to kill anyone?”

But the opposition remains. Public health experts against such positions include 129 who warned the World Health Organization and other public bodies not to “buy into the tobacco industry’s well-documented strategy of presenting itself as a partner.”

The article in The BMJ characterizes the debate as divided broadly between two types of doctor – public health experts looking at the population effects, and supposedly “idealist” about the issue, and doctors in practise who have a more “pragmatic” view of potential benefits for individuals.

While the debate rages, the reality of smoking versus vaping plays out.

A report from the Centers for Disease Control and Prevention and the Food and Drug Administration’s Center for Tobacco Products revealed that the use of electronic cigarettes tripled among middle and high school students between 2013 and 2014.

The news of the findings means that the use of e-cigarettes among this population has exceeded use of all other tobacco products – including conventional cigarettes.

Much of the opposition to the developments is a result of the involvement of tobacco companies, the report in The BMJ says.

“When they first came on the market, 5 or 6 years ago, there was a positive openness and curiosity” about electronic cigarettes, says Karl Fagerström, a Swedish clinical psychologist and a founder of the Society for Research on Nicotine and Tobacco. But after the cigarette industry became involved, the attitude changed from suspicion to opposition, he adds.

Written by Markus MacGill


Pulmonologist, Dr. Richard Le on Vaping

Recorded May 2014.

This is an interview with Dr. Richard Le, M.D., F.C.C.P. In other words, he’s a pulmonologist, a doctor who specializes in treating lung conditions. Many of his patients are smokers suffering from COPD and other smoking related illnesses.

I visited him on his day off at his home office in Anaheim, CA. He asked me if I wanted him to put on his “doctor’s outfit” for the interview. I told him it would look good for the video, so he did.

I asked him what he thought of e cigarette and whether he recommends it for patients looking to quit smoking. From a legal perspective, he is only allowed to recommend products which are FDA approved. That said, he cannot stop his patients from trying vaping as an alternative cessation device. He does recommend they try approved methods first. If those products fail, he says they can try vaping.

Chantix, which he recommends to patients, has a 14% success rate after 6 months of use. Also, Chantix can cause users to have suicidal tendencies. There are reports of actual suicides linked directly to the use of Chantix. It’s unfortunate that he is mandated to only recommend approved methods. The silver lining is that it is possible for the FDA to withdraw approval for certain drugs found to be harmful. It’s also possible that vapor products will be FDA approved in the future. Maybe doctors will be able to recommend electronic cigarette instead.

I am thankful that he would take the time to do this interview with me. Most doctors are not as open about their personal opinions about vape. It is a risk with no reward. Unlike the big pharmaceutical companies, we do not offer kickbacks to doctors for promoting our products. Having spoken with Dr. Le, I don’t think that would affect his decisions anyway.

Thank you Dr. Le for practicing medicine with integrity. Too bad the system does not allow more of that.


Nicotine Itself Isn’t The Real Villain

The man in charge of tobacco regulation at the Food and Drug Administration says we “need a national debate on nicotine.” Good idea. But first we need to understand what nicotine is – and what it isn’t.

It isn’t the stuff that can cause serious illness and death from cancer, lung, and heart disease. Those culprits are the tar and toxic gases that are released from burning tobacco when you smoke.

Nicotine is a chemical that is dangerous not because it causes cancer but because it can addict you to cigarettes. As Michael Russell, the father of tobacco harm reduction theory and the developer of nicotine gum, put it in 1976: “People smoke for nicotine but they die from the tar.”

Mitchell Zeller, director of the Center of Tobacco Products, a division of the FDA, made his comments about nicotine in an interview with New York Times columnist Joe Nocera on the eve of his agency’s recommendations for regulating electronic cigarettes.

The nature of e-cigarettes is that, like Russell’s gum, they contain nicotine and thus satisfy the cravings of smokers, but vaping – as puffing on an e-cigarette is called – doesn’t burn tobacco and release those carcinogens. Unfortunately, many Americans don’t understand that nicotine itself isn’t the villain.

Adolescents in the early 1980s encountered an evil character called Nick O’Teen, created by DC Comics in collaboration with the Sacramento-based Health Education Council. Nick O’Teen sparred with Superman, who tried to guard Gotham’s children against cigarettes.

But nicotine is only a menace when it can addict people to conventional cigarettes – that is, tobacco wrapped in paper. By contrast, in the process of vaping, nicotine carries little risk by itself. Negative health consequences have not materialized within the seven years e-cigarettes have been used in the U.S. – though it’s essential to keep monitoring.

In the 1960s, most psychologists, psychiatrists, and pharmacologists viewed smoking as a psychological and social habit. “Habit” was also the language used in the landmark 1964 Surgeon General’s report on smoking. At the time, some researchers suspected that nicotine played a role in cigarettes’ appeal. Drugs such as alcohol, barbiturates, and heroin are considered addictive (as opposed to habitual) based on their ability to intoxicate, cause social damage, and produce dramatic physical withdrawal syndromes. But smoking was considered neither a pharmacological nor biological phenomenon.

Not until 1988 did the U.S. Surgeon General designate smoking as an addiction, driven primarily by nicotine, which is a nitrogen-containing chemical, or alkaloid. Nicotine was deemed to have addictive properties based on three fundamental features: (1) in the initial stages of use, more of it is required to produce the same effect in the smoker, a phenomenon called “tolerance”; (2) it is “reinforcing,” meaning that it is sufficiently rewarding to spur self-administration; and (3) abrupt cessation can lead to powerful craving and a recognizable withdrawal syndrome.

Nicotine is a mild stimulant and poses negligible risks in healthy people. It enhances the performance of some tasks, especially those involving vigilance and rapid visual cue processing. It can also sharpen memory, concentration and attention in the short term.

Also, because nicotine receptors appear to regulate other receptor systems, its effect can vary according to one’s mood and level of arousal. A smoker who feels anxious or stressed can be calmed with nicotine, and a smoker who is tired will perk up with nicotine.

When nicotine binds to receptors in the brain, it releases dopamine, a primary neurotransmitter. Dopamine plays an important role in modulating attention, concentration, appetite suppression, and movement. Dopamine’s effects on movement could explain why nicotine has shown some promise in ameliorating a disorder likeParkinson’s disease in primates. In humans, in fact, large epidemiological series have found lower levels of the Parkinson’s in older smokers. Also, patients with early stages of Alzheimer’sdisease show some improvement with nicotine when delivered via a patch.

By contrast, there’s no debate about the dangers of smoking. As the biggest preventable cause of mortality in the developed world, smoking can affect fetal development and significantly increase the chances of certain cancers, heart attack, and stroke. Smoking also worsens pre-existing diabetes.

But it’s essential to note that, in addition to nicotine, there are roughly 6,000 chemicals in cigarette smoke, so it is hard to know which components pose the greatest damage to health. For example, the carbon monoxide, nitrogen oxides and other gaseous constituents of cigarette smoke have been shown to reduce oxygen transport to cells, promote growth of atherosclerotic plaques in blood vessels, and make blood platelets sticky so that they clump together and form clots.

The relative safety of nicotine alone is clear from animal studies and long-term observations of people who have used medicinal nicotine for years. As a result,researcherscan be far more definitive when they conclude that gum, patches, lozenges, inhalers, and sprays – all of which contain medicinal nicotine — are not carcinogenic and do not increase the risk of heart attack or stroke, even in people with pre-existing cardiac disease.

Although nicotine is an addictive substance, e-cigarette vapor appears to be less addictive than cigarette smoke. According to work by Jonathan Foulds of Penn State University College of Medicine published[i] recently in Nicotine and Tobacco Research,vapers reported being less irritable when they did not have access to an e cigarette compared to their feelings of frustration when they could not smoke.

Vapers also claimed they were less eager to get to the first puff of the day than they did when they were smokers. They were also less likely to wake up in the middle of the night to vape than they were, in the past, to smoke.

Many e-cigarettes deliver less nicotine per puff and generally produce lower blood nicotine levels (and, thus, brain levels) than cigarettes do. However, with access to increasingly sophisticated devices and more experience as a vaper, the user can attain a blood level of nicotine that is comparable to that produced by smoking. Still, it takes longer for vaped nicotine to reach its peak level than for tobacco-burned nicotine.

These two variables – how high the level of nicotine is in the bloodstream and how fast that level is achieved — are important in determining the addictiveness of any abused drug. As expected, Foulds’s team found that subjects who used weak “ciga-likes” (first generation e-cigarettes that physically resemble actual cigarettes) had among the lowest scores on a test of “dependency,” or addiction. Also, the length of time as a vaper was positively correlated with the strength of dependence. As Foulds suggests, “we might actually need e-cigarettes that are better at delivering nicotine because that’s what’s more likely to help people quit.”

There’s no doubt vapor technology will improve the nicotine delivery of e-cigarettes. Indeed, a brand new type of e-cigarette uses nicotine extract that includes natural nicotine salts that are part of the tobacco leaf, approximating the nicotine delivery of a conventional cigarette. As this and other technologies develop and spread, nicotine delivery will become better and vape will become more attractive to more smokers.

Believers in harm-reduction theory see that as a good thing. If current tobacco smokers and likely new tobacco smokers choose vaping, they’ll cut their health risks – despite, or actually because of, nicotine.

In his interview with Nocera, Zeller said that “when nicotine is attached to smoke particles, it will kill.” Conversely, when there is no smoke, nicotine alone will be far safer, even a net benefit.

The question now is whether this reality can be translated into government rules that enable existing e-cigarette manufacturers to continue to innovate, to advertise to adult smokers, and to reassure the public that their products have been subject to high levels of quality control. After all, governments should regulate products according to the harm they pose, so the distinction between smoked and vaped nicotine really matters.

If policy makers reject the scientific truth about nicotine and make e-cigarettes more scarce, then the likely result is that more Americans will die from smoking.


Innokin Vape Network Giveaway

Innokin is proud to announce the first Vape Shop Employee Appreciation 1000 iSub Giveaway.

1000 iSubs have been made for 1000 Vape Shop Employees.

Do you work for a vape shop?

Are you an expert and want to work with Innokin?

Apply here and if you are selected,you will be sent an iSub and quite possibly more, plus also have access to more Innokin products.

We are starting with America and the U.K. and will be expanding internationally. If you buy from Innokin you will receive vapemail with your next order. If you don’t yet buy from Innokin we will get the iSub/Vape Mail to you or to an awesome Innokin Authorized Vendor who is close to you. You can make some friends and try out some great new gear.

Thank you for supporting vaping and being awesome. We hope to get this Exclusive Club going as a way to say thank you and get your feedback and offer direct marketing and also warranty channels and support. If you think you could help the Innokin Vape Network or Vaping and have a skill you would like to trade in exchange for gear then please let us know.

Lucky people will get new devices ahead of time – try them – give us important and useful feedback and we will continue to work together to make vaping better. Do you have a concept for something great? Can you use chopsticks? 😀

1) Register for the Innokin Vape Network here:

2) We will give away 1000 iSubs,a few hundred Cool Fire IV,MVP3.0 Pro and also the Disrupter throughout the giveaway.

3)Winners will be choosed by

4) This contest is international. If you would like to speak with an Innokin representative in your native language, please contact:

5) This giveaway will run indefinitely however there will be one of a kind devices for people who join in and help us out with feedback in exchange for support.