Another day, another lie by Glantz

Sorry for the re-use of this photo, but I really
can't be bothered to find another one of Glantz

Stanton Glantz is really on fire these days. Today I noticed he proudly proclaimed that some of his friends have done another longitudinal study shows that kids at low risk of smoking who use e-cigs are a lot more likely to progress to cigarettes. Using his computer skills to make some of the text bold, and thereby, in quite a clever way I have to admit, he's able to emphasize his point and what he thinks his friends have proven with this study:

What they found was that the kids who used e-cigarettes were 8.3 times more likely to be actual smoking cigarettes a year later.

Oh, really? Is that what they actually found? Well apparently they think they did. From the "At a Glance"-section of the study:

In analyses that controlled for all covariates, baseline e-cigarette use was independently associated with progression to smoking (adjusted odds ratio [AOR], 8.3; 95% CI, 1.2-58.6) and progression to susceptibility (AOR, 8.5; 95% CI, 1.3-57.2) among initially nonsusceptible nonsmokers.

Hmm... this doesn't smell right? In what way did they twist reality to come up with those numbers? I have to admit I kind of cheated a bit and went straight on to Michael Siegels blog to see if he had already read the study and pointed out the lies. Of course he had, and he confirms a sneaking suspicion I had: They've created an alternative definition of a smoker. Well actually, from what I can see (I haven't really read the study that well yet), they don't really define a cigarette smoker in the study but rather a cigarette smoking initiator. Still they write about this as if they were the same thing. So what is a cigarette smoking initiator then?

... a cigarette smoking initiator, defined as someone who has smoked at least 1 puff of a cigarette in her or his lifetime

Oh? By that definition I'm actually still a smoker, right? Actually I think I remember taking a puff of my mothers cigarette when I was like 6 (sorry mum, I don't think I ever told you that), so I've been a smoker since I was 6 then. No wonder I was in such a bad shape when I hit 25. I'm also pretty sure my teenagers are alcoholics as I know for a fact they have tasted beer. Oh, Lord...

I guess most people can see why such a definition of smokers by itself makes this whole study was total waste of time, and the published results nothing more than a big fat lie. If you don't, or just want a good read, I recommend reading Dr. Siegels thorough explanation here.

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New report from Norwegian Institute of Public Health causes more harm than health

Today the Norwegian Institute of Public Health of published a report called "Health risks associated with the use of electronic cigarettes". The report can be found here and there is also a summary in English.

Norwegian media has been publishing stories today claiming that "second-hand vaping poses health risks", giving the impression that e-cigarettes are as dangerous to bystanders as tobacco cigarettes, which of course is not at all what the report says. The report itself contains quite a few serious mistakes as well, but it concludes that risks associated with all other substances other than nicotine is negligible. It also concludes that cancer risks from nicotine itself, if any, is negligible. 

The biggest problem with the report is that it focuses a lot on potential health risks of nicotine, especially to bystanders. This is all based on a false assumption that the nicotine in second hand smoke poses a risk to bystanders in itself. One of the studies they base this on is this one, that concludes that people who live in smokers homes and e-cigarette users homes absorb statistically similar amounts of nicotine. Now I'm no expert so I'll just have to trust this even though it looks to me from the summary of the study that those in the smokers home gets twice the amount. But that is not the point. The point is that these amounts don't pose any danger to the people exposed to them. Dr. Farsalinos showed us this, with reference to the same study, with some simple maths here. (His numbers seem a bit different than those presented in the summary, but I assume he found more significant numbers in the actual study). The amount of nicotine absorbed by a "passive vaper" is 10 times lower than The European Food Safety Authority say will affect an average human weighing 75 kg (and of course you should not fill your home with vapor if you have babies... but that goes without saying). This also means that the same human being is also unaffected by the nicotine from passive smoking, and this is where the Norwegian Institute of Public Health misses the whole point and causes more public harm than health. Even if passive vapers absorb similar levels of nicotine to what passive smokers do that does not pose any health risks to them. The other particles that tobacco smoke exposes bystanders to is another story. As Dr. Farsalinos points out:

Such a levels is not only harmless but has absolutely no biological effect, even according to the strictest regulatory definitions.

When it comes to the amount of nicotine absorbed by the vapers themselves they also say that these levels are the same as for smokers, which is probably not far from the truth. However, the negative effects of nicotine is also debated. There are some proven, unwanted effects on fetuses which means you shouldn't use nicotine while pregnant but other than that there's not much to be afraid of. In fact there are a lot of positive effects of nicotine use as well (for healthy, non-pregnant people that is). Then there is the question whether nicotine in itself is addictive, to which most serious scientists today would answer no. I've written quite a bit about this earlier: Nicotine - a supersheep in wolf's clothing?

Another big problem with the report is that it is almost 100 pages long, and that a lot of it is used to describe potential problems with substances that are not present in amounts that will cause those problems. This only serves to scare people (or just scare them away from reading the report), which might not notice the last sentence of the paragraph that says this won't be a problem anyway. And apparently both the media and our minister of Health has fallen in this trap. The minister of health said today that he has up until now thought that e-cigarettes are virtually harmless but he is now worried by this report. This shows how much damage this report has already done. The Norwegian Institute of Public Health have caused more harm than health as I said, by writing conclusions that do not reflect the actual content of their report. The conclusion that comes forth is one that is based on a false assumption and an error in the report: Nicotine from passive vaping can cause harm. The contents of the report (even with this error) justifies a conclusion more in the line of this: E-cigarettes are orders of magnitude less harmful to both vapers and bystanders compared to cigarettes. I really hope (and I do believe) that SIRUS and Karl Erik Lund will turn up in the media shortly and minimize the damage. I do feel a bit sorry for them as this probably feels a bit like a punch in the face.

 

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Some great news from Dr. Farsalinos and his team

This morning I was made aware of an update published on the indiegogo project page that Dr. Farsalinos and his team set up for their upcoming study on "Temperature of evaporation, liquid consumption and vapor analysis in realistic conditions." It looks to me that we can expect some very good and very important papers being published soon, one of them already submitted for publication and Dr. Farsalinos gives us some good news about it:

This study is extremely important, and I can reveal that the results were better than expected. It seems that the dry puff taste is a very sensitive natural defence mechanism, which is detected at very low levels of aldehydes. In that study, we have also measured the temperatures but we decided to report them in a separate paper.

You might remember the horror-story about e-cigarette vapor containing lots of formaldehyde that was published in media all over the world in January. Dr. Farsalinos was quick to point out the obvious flaws and wrongly drawn conclusions back then, criticizing the misinformation published. Even the authors of the study kind of agreed to a lot of his criticism, giving us the real reason they published it: "We just wanted to get it out". Despite all this I still hear people claiming that e-cigarette vapor contains 10 times more carcinogens than cigarette smoke. This new paper by Farsalinos and his team looks like it is going to prove his theory that unrealistic dry-puff conditions is the reason behind such results... and then some.

The thing I like most about Dr. Farsalinos work is that he looks for possible real-life issues with e-cigarettes, and provides information and ways to eliminate these problems should they occur. His effort to study how temperatures affects the content of the vapor will provide extremely important information for the industry and will make their efforts to develop safe products a lot easier. Some people are unable to recognize the potential of the e-cigarette, and focus only on finding problems. Dr. Farsalinos and his team focuses not only on investigating potential problems, but they also give the industry the information they need to develop products that are a safe as possible.

If e-cigs were so damn dangerous, wouldn't they be gone by now?

Reading this article yesterday made me start thinking a bit. Titled "There's no evidence e-cigarettes are as harmful as smoking" this article by Linda Bauld (Professor of Health Policy at the University of Stirling and Deputy Director of the UK Centre for Tobacco and Alcohol Studies) is an answer to another article by Nash Riggins claiming the opposite, which of course is just pure non-sense, as Bauld points out. I couldn't agree more with what Bauld chooses to end her answer with:

These products are a disruptive technology and debates on their merits will continue. However, while it does, those who feel moved to comment should do some reading first.

I've said before, and it doesn't hurt to repeat it I guess.... If you really don't know enough about e-cigarettes and vaping by now, please leave the debate to someone who do. OK? In fact Riggins is even worse than those who claims they don't know enough yet... he fills in his blanks with stuff he just makes up to support his agenda.

Anyway, as I said, Bauld's article made me think a bit. There is no evidence e-cigarettes are as harmful as smoking. Actually there is not much evidence that e-cigarettes are harmful at all, is there? Despite the massive efforts from Big Pharma, some tobacco companies, governments, WHO, EU and tobacco control to get rid of the e-cigarettes, they haven't really managed to come up with much. Together these players have almost unlimited funds, and they have used a lot of time and money on this, but still they got... well not much really. There is of course the risk of exploding batteries and children getting poisoned from e-liquid left unattended. Those you can prove, but you can't really say e-cigarettes are responsible for these hazards. They are the results of irresponsible behaviour. Cellphones and computers also have exploding batteries, and your house is probably full of stuff that can kill your kids if they can get their hands on it and drink or eat it. If there are accidents with these phones, computers or household articles, we some times get debates on how to make these products safer, or how to avoid kids getting hold of them, but whenever it happens with something e-cig related, there are shout outs for bans. Why? In fact I think Dr. Farsalinos is the one that has come closest to showing some potential harm from e-cigarettes used how they are supposed to with his diacetyl study. There is a lot of research available, providing evidence that a lot of the fears presented by e-cigarette opponents are in fact nothing to be concerned about. Maybe it's not that strange? I mean that the people who are able to see the full potential of e-cigarettes as a technology that can put an end to the tobacco epidemic, are also the ones that are able to come up with the real potential harms. Because if there are potential harms, we should find them and eliminate them, making e-cigarettes as safe as possible. Banning or over-regulating e-cigarettes because we find some harmful substance in some e-liquid is madness. It would be like banning cars because someone makes one with malfunctioning seat-belts... instead of just making them put in proper seat-belts.

So why is then, that despite their efforts to find something that will kill the e-cig,  they haven't managed to do so in... what is it now ... like 7 years? Could it be that they are using their money on lobbying and making up theories instead of doing some real research? And if so, why are they doing that? Could it be that they have some common sense after all and have seen what the rest of us have... that there is no real cancer-risk, there is no gateway effect and most importantly: These products are a disruptive technology that works so well they can potentially threaten their income.

Think about it... if e-cigarettes really were causing cancer at the same rate as smoking, or if they were less effective than Big Pharma's NRTs... do you think they would try so hard to get rid of it? If the EU didn't really see the e-cigarettes potential to take over the nicotine market, why would they want to put sin taxes on them? Why do you think the tobacco companies are trying to enter the market and wipe out their competitors by lobbying for regulations favouring their version? Why is it that anti-smoking organizations are opposing this? Could it be that they see that these products can wipe out their basis for existence? And why is it, that despite their combined efforts and almost unlimited funds, neither of these guys have managed to come up with some real cause for concern in so much time? Maybe there is none? If e-cigs were so damn dangerous, wouldn't they be gone by now?

photo credit: E-Cigarette/Electronic Cigarette/E-Cigs/E-Liquid/Vaping via photopin (license)

New study by Dr. Farsalinos: Dual users more worried about E-cigarette risks

In a study published by Dr. Farsalinos and his team have examined the factors associated with dual use of tobacco and electronic cigarettes. In other words, why the dual users don't stop smoking tobacco cigarettes completely. In a comment published today Dr. Farsalinos says that their most important finding was that the strongest predictor of dual use was high risk perception for e-cigarettes. This shows how the misinformation and lies published about e-cigarettes actually keep people smoking, most probably shortening their lives by years. To add to that, Farsalinos suspects we're only seeing the tip of the iceberg here:

Although expected, this is a very important finding because it shows that misinformation and exaggeration about e-cigarette risks is discouraging smokers from making a complete switch. Considering that the survey was performed in dedicated users, I expect that this factor will be even more important for the general population. Moreover, I think that it is not only associated with dual use but also with failure to reduce smoking or with relapse to smoking.

Again, we come back to the fact that it's very important to get proper, true information out to the public, and the media will be the key to doing this. I'd like to shout out a big thanks to Dr. Farsalinos and his team for their work and efforts to spread the truth about e-cigarettes to the public. Thank you!

Another flawed study on Formaldehyde in E-Cigarette Aerosols

Yesterday another vaping horror story, based on this junk science, hit the media (for example here). I guess it was just a matter of time before it happened again. This time Dr. Peyton and Dr. Pankow at Portland State University in Oregon have used a puffing machine of some kind and found that you'll detect a lot of formaldehyde if you run a CE4 top-coil atomizer at 5 Volts (generating like 12W) and do 5 second puffs. This means, you do ONLY dry-puffs! Of course no-one in real life would do this so the study is totally irrelevant on only serves to show the incompetence of it's authors. If you run it at 3.3 Volts, like anyone with taste-buds would do, not surprisingly no formaldehyde was detected. Our dear doctors then came to the conclusion that vaping is 5-15 times as dangerous as smoking. I'm baffled that someone is able to publish such crap, and I'm just sad that the media once again takes the bait. This is like testing the safety of seat-belts in cars by strangling people with them.

AVA, Clive Bates, Dr. Siegel and Dr. Farsalinos already wrote great comments on the case explaining how bad this so called research is, and Dr. Farsalinos also wrote another comment verifying the equipment used in the "study". I suggest everyone bookmarks these comments and send them to anyone confronting you with this non-sense. And my God I look forward to the day Dr. Farsalinos' study on temperature of evaporation, liquid consumption and vapor analysis in realistic conditions is published so we can put an end to this formaldehyde scaremongering.


photo credit: tbecreview via photopin cc

How many e-cig studies can you fit in your hand?

Yesterday Steve K made me aware of this "Decent Article Derailed by Japanese Study". Reading the original article I see that the Japanese horror story and the following copy-paste journalism is still doing a lot of damage, kind of destroying an otherwise pretty good article about e-cigarettes. And then there is this:

The combination of uncertainty and the small handful of studies published to date mean that e-cigarette use is a gamble. There’s just not enough information to say for sure whether they are bad for you, or rather just how bad they are for you, considering the initial argument that they are far less harmful than tobacco.

Small handful of studies? I do realize that USB memory sticks today can fit a shitload of data, so technically this might be true, but seriously I do not think that was what they meant by this. Have a look at this study by Frank J. Domino, MD, published yesterday. The authors found and reviewed 99 full-text research papers. Is that a handful? Or how about all the studies collected on ecigalternative.com. Can those fit in your hand? As I said above, I assume that when they say a handful that is figuratively speaking, and in my opinion, if you are capable of using a handy tool called google, you should be able to dig up a lot more than a handful of studies. In fact I would say that Dr. Farsalinos studies alone would be around a handful... maybe two. But still I see the same thing in the media all the time: There is not much research done in the area yet. How is it even possible to state that when you obviously are able to access the internet... oh wait.. I just got it: Copy-paste journalism again. Damn...




photo credit: M Prince Photography via photopin cc

E-cigarettes contain up to 10 times carcinogens.... NOT! (Updated)

Important update: Read Dr. Farsalinos' statement on ecigarette-research.com about this: 
http://goo.gl/GY3Ibj

Today a lot of major newspapers picked up on a Japanese study that apparently has found that the vapor from e-cigarettes contains up to 10 times the amount of carcinogens compared to traditional cigarettes. The Daily Mail is just one of the, and almost all major Norwegian newspaper picked up on the story with headlines like these: "Scientists say that e-cigarettes are very carcinogenic", "This is very dangerous" and "Scientist made shocking discoveries in e-cigarettes".

None of the tabloid media has from what I've seen yet provided any link to the original study, but apparently this is the one they are referring to: http://www.mdpi.com/1660-4601/11/11/11192/htm. As you can see this study has Dr. Konstantinos Farsalinos listed as an external editor. Dr. Farsalinos commented on this on his own facebook page today:

In the study you mention (table 1) the highest level they found was 8 times LOWER than tobacco cigarettes!!!

Later he refers to this article to show the amount of carbonyl compounds found in cigarette smoke: http://www.ncbi.nlm.nih.gov/pubmed/18062674

Here they found 200ug/cigarette in mainstream smoke (what you inhale) and 880ug/cigarette in sidestream smoke!

And when asked if vaping still is safe he answers this:

If you don't vape with a dry wick, you are much better than smoking...

Cause basically, if you read the research in question, what they found is these compounds come from oxidation of e-liquid or wicking material, not from vaporizing.

Also have a look at the conclusion of the original study:

Studies have shown that e-cigarettes emit toxic carbonyl compounds, generated from thermal decomposition. These substances can have adverse health effects; however, in most cases, the levels are lower than those in tobacco cigarette smoke. It is important to expand the research in this field, to better understand the source of carbonyls emitted from e-cigarettes and find ways to reduce them.

So from the FACTS I mention above I can only draw the following conclusion when it comes to this "sensational" story that hit the world today: This is pure propaganda, based on lies probably fed to shitty journalists, hungering for their next big scoop, by ANTZ or Big Pharma themselves.

UPDATE: I also recommend reading this post from ecigadvanced.com on the subject for further information: http://goo.gl/eFFDEZ, and also this post from the Ashtray Blog: http://goo.gl/eshOZC



photo credit: TaylorErinn via photopin cc

"2014 worst published study award" - The nominees are

Looks like Clive Bates managed to find another canditate for the "2014 worst published study award": www.clivebates.com/?p=2426. Quite an amusing post by Clive pointing out how utterly useless this "research" really is.

There you go - problem solved

The topic at hand now is "3rd hand exposure" to nicotine, and you can read the whole study here: http://goo.gl/o0BkK9. The authors of the study found out that nicotine is actually left on walls, windows and so on in a chamber, and from that they conclude that people will be exposed to it "3rd hand". But, as Clive points out, there is a quite important difference between deposition of nicotine and exposure to nicotine. This is Clive's response to our dear Dr. Glantz's praising of the study on his blog:

The main risk appears to be to people who lick windows – or ‘window-lickers’ as they are known on the Internet.  However, even these people, who have other problems and priorities, would have to lick the deposition from 38 square meters* of glass in this chamber to be exposed to 1mg of nicotine (47/6*1000/205).

I don't really think there is anything else to say about this. Go read Clive's post if you haven't yet. Oh, and I've put up a poll on the right hand side so you can vote on which of the 3 studies I've written about lately that you think should get the "2014 worst published study award". Who will win this prestigious award? The nominees are:

• "3rd hand exposure" by Goniewicz and Lee
• "Scary warning labelz" by Popova and Ling 
• "Creative Cancer research" by Borderud, Li, Burkhalter, Sheffer and Ostrof

Upcoming report on e-cigarettes and user culture by SIRUS

As Karl Erik Lund mentioned in the interview I published earlier this week, SIRUS is soon to launch a new study on e-cigarettes. This project is lead by researcher Rikke Tokle and she introduced the case in the Norsk Dampselskap (the Norwegian union of vapers) facebook group earlier this week. I sent Rikke an email offering to be a participant in the study and asked her a little about what it was all about.

This is what she says about the project:
The project is still in the start-up phase, which means the research questions to be investigated is still relatively open. I operate with a preliminary working title which is "E-cigarettes and user culture", but this will probably be changed as the research questions will be changed or added when the data collection starts. The background for SIRUS to start this project is the desire for more knowledge and focus on the users and their experience with using e-cigarettes. It is also interesting to catch up on new words and expressions that occur around "new" phenomenons - for example "vaping" (editor: "damping" in Norwegian). There is a lot of good information to be gathered from Dampselskapets (editor: the Norwegian union of vapers) web-pages and blogs like yours (editor: Thank you). This information will be supplemented by individual interviews with users of e-cigarettes in and outside the forum.

I think this looks very interesting and I'm looking forward to following the study as it progresses. Any Norwegian readers who wants to participate in the study can contact Rikke Tokle at rt(at)sirus.no. Let's give her a proper kick-start on the project. I'll keep you guys updated :)

Interview with Karl Erik Lund, Research Director for the SIRUS tobacco unit, Part 2

I hope you all found yesterdays reading interesting. It was at least an all time high pageview count on the blog. I for one am waiting eagerly to see the results of the upcoming study of the culture of vaping that Karl Erik talks about. Here is part 2 of the interview. 

Vaping Giraffe: Let's think of a scenario where all smokers switch to e-cigarettes. This would of course lead to a massive change in public health and economy. One would think a lot of money could be saved since treatment of smoking related diseases would be massively reduced. On the other hand it might lead to people living longer (which would be a cost) and reduced tax income from cigarettes. Do you know of any calculations done on such or similar scenarios?

Karl Erik Lund: I do not approve of such an approach. In the Check Republic, spokesmen for the tobacco industry stated that tobacco gained the economy because smokers tend to die before they became a burden on the social security budgets. This is absurd! Any such calculation that somehow makes an early death profitable for the state economy has an unethical sentiment.  The ultimate goal for a reasonable health policy should be to help people live healthier and longer lives, unaffected of any economic cost-benefit analysis. In Norway where the tobacco-specific tax are very high, smokers probably ‘pay their way’. They have higher sickness rates and charge the public health system more heavily, but the accumulated amount already paid to the state through taxation will probably cover for this. In other economies where tobacco taxation is low and health care costs is covered by the individual and not the public, the situation might not be the same. Non-smokers tend utilize the health care system somewhat less, but live longer and receive pensions for a longer time. Again, I think such kind of calculation is a ‘red herring’, and that promoters of e-cigarettes should abstain from this approach.            

Vaping Giraffe: What do you think is the health authorities main reason for keeping the ban on e-cigarettes with nicotine?

Karl Erik Lund: Spokesmen for the Directorate of Health have repeatedly used the precautionary principle to justify the ban on e-cigarettes. Some also fear that e-cigarettes will renormalize smoking, and other keep using the gateway-argument – even though there is no empirical evidence for either. The precautionary principle opens up for a really interesting discussion. The human costs of a continued ban are very high, smokers are buying lousy and potential risky e-cigarettes over the internet and the ban is an obstacle for smokers to move down the risk continuum of nicotine products. You have to weight these costs against the gains from a precautionary principle. Applying a rational decision model approach, one will find limited support for the precautionary principle.    

Vaping Giraffe: I've read that around 70% of the worlds tobacco consumption is done in developing countries. Still I can find very little about e-cigarettes in these countries on the web. What is your thoughts on that? Are you familiar with any projects in developing countries?

Karl Erik Lund: Even if e-cigarettes have originated from China and much of the production takes place in China, the popularity of e-cigarettes have occurred  in typical developed nations. Following a diffusion-of-innovation model, e-cigarettes will eventually become popular in developing countries as well. Most tobacco-related deaths take place in countries like China, India and Indonesia, which means that e-cigarettes potentially can have an enormous impact on public health. I am not familiar with any projects going on in that part of the world at the moment.  
 
Vaping Giraffe: The tobacco industry and the pharmaceutical industry are two of the largest industries in the world, both now looking at a new competitor that will take a lot of customers from them. What do you think their strategy for keeping the customers are?

Karl Erik Lund: Until now, the pharma industry has been somewhat hesitant to enter into the e-cig business. Their strategy has been to fight the e-cig diffusion through political lobbying. The tobacco industry, however, has been more ambivalent towards e-cigarettes. Right now Big Tobacco are test-marketing their own products, so they have every intention to enter into the e-cig business. For the consumers, this is probably a good thing because they can afford to invest a lot of money which eventually will result in better products on the market. At the same time, Big Tobaccos engagement is bad news for the e-cig proponents advocating for market access. Politicians and policy makers connote bad representations to all products from Big Tobacco.     

Vaping Giraffe: The EU is from what I understand in the finishing stages of a new tobacco directive. Does Norway have to follow this directive, or can we choose not to?

Karl Erik Lund: There is a formal choice, but every practice indicates that Norway will follow the EU-regulations. However, as the tobacco-product-directive looks right now, before the final negotiations between the Parliament, the Commission and the Council, the member states can decide by themselves whether e-cigarettes should be regulated as a medical device or a consumer product. 
 
Vaping Giraffe: Have you heared of "Norsk Dampselskap" (the Norwegian Union of vapers) and if so what do you think of their work?
 
Karl Erik Lund: Yea, I take great pleasure in reading posts on their wall. Many competent people acting as counsellors and giving great advices to novices in vaporing. I am really touched by all the personal histories from smokers who have replaced tobacco by e-cigarettes.  
 
Vaping Giraffe: Do you have any recommendations for vapers that want to fight for their case? How could ordinary people get engaged?

Karl Erik Lund: Consumers groups are very powerful and have great impact on politicians and policy makers. We must not underestimate their potential influence. I was lucky enough to participate in a meeting with members of the European Parliament in October last year along with Clive Bates, Gerry Stimpson, Jaque LeHouzac and Konstantinos Farsalinos – all world-leading specialists on e-cigarettes. We were amazed how the politicians appeared to be attentive and responsive towards consumer groups. Letters to politicians is still a powerful channel of influence.  

I'd like to send a big thanks to Karl Erik Lund for taking the time to answer this. I'm really looking forward to following the research done by him and SIRUS. I did also notice that one of his colleagues posted on the "Norsk Dampselskap" Facebook group asking for participants for the upcoming study mentioned in part 1. I'm in!

Interview with Karl Erik Lund, Research Director for the SIRUS tobacco unit, Part 1

I've mentioned Karl Erik Lund, Ph.d. and Research Director at SIRUS, several times already on my blog. He has been in the media quite a lot lately, speaking about his research on e-cigarettes, and commented on the politics that has evolved around them. Should they be banned, regulated as medicines, regulated as a tobacco product, can they save lives etc. I had some questions I wanted to ask him... so I sent him an email and asked if I could do an interview, which he happily (I hope) agreed to. This is the first part of this interview. Hope you guys find it as interesting as I do, and stay tuned for the second part tomorrow.

Vaping Giraffe: Could you first tell us, in short, what is SIRUS and what is your role/position there?

Karl Erik Lund: The Norwegian Institute for Alcohol & Drug Research is an independent research institution but at the same time an administrative government body under the Ministry of Health and Care Services. SIRUS conducts social scientific research, compiles documentation and provides information on substance use and abuse. Work is divided into three areas, each catered for by a dedicated research team: alcohol research; drugs research; and tobacco research. I have been the Research Director for the tobacco unit since 2006.

Vaping Giraffe: When did you first hear of the e-cigarette, and when did you decide to do research on them?

Karl Erik Lund: As an assistant editor in a scientific journal – Nicotine & Tobacco Research – I handled perhaps the first of several subsequent papers on e-cigs submitted from Dr Polosa and his pioneering research team in Italy, and this must have been about three years ago. Since then, I have followed the very heterogeneous research on e-cigarettes very closely. In October 2013 I published a comprehensive review (70 pages) of the international research on e-cigarettes concerning use, motives for use, results from animal studies, analysis of chemical substances, acute physiological consequences, effects in smoking reduction and cessation etc.
  
Vaping Giraffe: Could you tell us a little about your findings? How dangerous is the e-cigarette (with nicotine) compared to a normal cigarette?

Karl Erik Lund: Even if we do not have exact knowledge of any long-term health consequence that might occur, there is scientific consensus that e-cigarettes are far less risky than conventional cigarettes. We are not saying that vaporing is totally risk-free, but the magnitude of risk between inhaling tobacco from a cigarette that burns and clean nicotine thorough mist is probably huge.  

Vaping Giraffe: Are you familiar with other researchers in other countries that have come to other conclusions than your own? If so, do you think these are unbiased?

Karl Erik Lund: My impression is that most – if not all - researchers do recognize the large different risk potential between the two products, but some researchers tend to emphasize that some e-cigarettes still contain toxic substances more than they want to focus on the risk-reduction aspects. For researchers that aim for a totally nicotine-free society, a transition from tobacco to e-cigarettes have no value. It really depends on the perspective of the researcher – you are either in favour of a harm reduction approach in tobacco control or you are not.    

Vaping Giraffe: Do you, or SIRUS have any on-going studies concerting e-cigarettes you can tell us about right now?
 
Karl Erik Lund: Yes, we are about to launch a project in which we aim to study the culture of vaporing. What characterize the users, what are their motives, what impact has the ban on e-cigarettes on the in-group mentality and the way they communicate about e-cigs. Do e-cigarettes recruit youngsters who otherwise wouldn’t have started to smoke cigarettes? We will also monitor the use of e-cigarettes in population-based surveys over the next years. In addition, we will study changes in the nicotine market. What will happen on this market if the authorities decide to let e-cigarettes compete with tobacco cigarettes, snus and pharmaceutical nicotine? 

Vaping Giraffe: A lot of pro-e-cigarette people shake their heads when the authorities claim there is to little research done on the health effects of e-cigarettes to allow them. They say the research is done and available on the internet, most of it concluding that e-cigarettes are close to harmless both to the user and the surroundings. Can you comment on this?

Karl Erik Lund: I am really impressed by the level of knowledge of some members in the user organizations. They seem to be very on top of new research, and I learn quite a lot thorough reading posts on Facebook and other websites that organize vapers. I do understand their frustration when health authorities repeatedly claim that the scientific base still is too weak to lift the e-cig ban. On the other side, we have to understand how the health authorities work. In order to act, they want knowledge established thorough systematic reviews, long time observations and randomized controlled trials. The burden of proof has been put on the producers that do not have the skills or the resources to conduct such advanced research. The authorities have used – or some would say misused – the precautionary principle in order to keep a clearly risk-reducing and perhaps life-saving alternative out of reach for smokers. The costs of the precautionary principle are very high, and based on what we already know many feel it is enough for the authorities to act.      

Vaping Giraffe: What is SIRUS relation to the department of health and have the health authorities asked SIRUS to do any research on e-cigarettes?

Karl Erik Lund: The Ministry of Health and Care Services do support our research and our updates on e-cigarettes. We are instructed by the Ministry to initiate debates on harm-reduction alternatives, even if the anti-tobacco community might find this provocative. There is a lot of understanding for a tobacco harm reduction approach among politicians, policy makers and particularly among researchers. The tobacco control movement seem to be more hesitant and some are even very hostile.

Vaping Giraffe: Do you think e-cigarettes could solve the "tobacco problem"? And do you think the health authorities here in Norway will repeal the ban in time?

Karl Erik Lund: I am quite certain that e-cigarettes will make their way to the marked. The remaining question is what kind of regulation that will replace the ban. There are toxicants in e-cigarettes that do not have to be there, so we need regulation standards in order to improve product safety. The new government seems to be willing to assess the appropriateness of the ban, and the new Tobacco-Product-Directive in EU will also put a pressure on Norwegians policy on e-cigarettes. I do not think availability to e-cigarettes will solve the tobacco problem entirely, but I am quite certain that it might help. We have approximately 1 million smokers and 200 000 of those do not manage or do not want to quit using nicotine. Now, we are forcing this crowd to use the most dangerous device for nicotine uptake, even if we know that a very harm-reducing product exists. We also know that 10-15% of teenagers in future generations will start to use tobacco. It is not so much the efficacy of e-cigarettes as temporary aids to cessation, but their potential as long-term alternatives to tobacco that makes the virtual elimination of tobacco a realistic future target.