Tuesday, March 10, 2009

Electronic Cigarettes

I appeared on the local news regarding electronic cigarettes. This is a follow up to a piece on the CBS morning show (see video below). The more closely I investigated this issue, the more I became concerned.






Electronic cigarettes are nicotine delivery systems that look like actual cigarettes. When the user inhales, the nicotine in cartridges within the elecrtonic cigarettes vaporizes the nicotine and it is inhaled. In addition, part of the process leads to the appearance of "smoke," though this is not really smoke, it is essentially water vapor. Though the lack of actual tobacco in these products is theoretically better than cigarettes in some way, mainly decreasing the carcinogenic effect and eliminated harms from second hand smoke, the electronic cigarette is dangerously being promoted as safer alternatives to cigarettes that contain tobacco as well as possible aids to smoking cessation. Make no mistake: these products are not safe, in some ways could be riskier than cigarettes, will not be effective smoking cessation aids, and are scarily unregulated by the FDA and far too available in the US.

Manufacturers and sellers will claim that there is research to support that they are safe, but these are mouse and not human studies, and they are done not by goverment agencies like the FDA, but by the products manufacturers. Thus, there is not good evidence that these products are safe. Though tobacco cigarettes are known to be dangerous, these should not be considered a safe alternative.

Unlike other nicotine products sold in the US like the patch, gum, and lozenge which has gone through intestive testing, the e-cigarette has not. More importantly, the purpose of these approved products is that they slowly release nicotine to help people quit tobacco, and they have studies that prove they work. By vaporizing nicotine, and inhaling it, this will lead to very rapid absorption, and high levels of addiction; possibly even higher than real cigarettes themselves.

Currenlty, most e-cigarettes are made in China and bought on the internet, where it is very difficult for federal agencies to regulate. However, unlike tobacco, which does not (yet) come under FDA jurisdiction, these products are clearly drugs. Though the FDA may have limited ability to stop what is being sold on the Internet from other countries, they must do a better job in regulating what is sold here. These products are being sold in shopping malls in the US, and this must be put to a stop. The World Health Organization has called for the manufacturers of these products to stop making and promoting them.

The good news, is that the rate of smoking in the US has decreased. More importantly, there are very effective ways of quitting. If you are a smoker and interested in quitting, the best thing to do is to speak with your doctor, who can help you work on changing habits and behaviors. There is now very good evidence and current guidelines recommend that EVERY smoker interested in quitting be offered medication. This can be in the form of nicotine replacement such as the patch or gum. Pills have be shown to be even more effective and both bupropion and Chantix are available by prescription. Finally, call 1-800- QUITNOW, a free 24/7 counselling service.

video

Watch CBS Videos Online

63 comments:

Anonymous said...

Dr. Mintz,

Allow me to educate you. You forgot to mention NICOTROL INHALER, FDA APPROVED May 2, 1997,4mg, ORAL INHALANT, PHARMACIA AND UP JOHN (Company) An inhaler the same as an E-cig.

You are correct over 46 million adult smokers have QUIT. So don't talk to me about cigarette addiction in this country. People make addictive choices everyday that affects me. They include : one in every American is an alcoholic (an overhealth care cost 166 Billion a year)

70% of rapes alcohol related
80% emergency room
41% falls
45% fires
41% drowning
50% suicides
86% homicide death
49% convicted murder or attempted
50% car crash deaths
57% child abuse and spousal battery

Alcohol and Cancer NIAAA Pub.99-4323 , 2002
Liver disease
heart disease
Pancreatitis
Cancer of the Esophagus, MOUTH, THROAT, AND LARYNX
BREAST CANCER IN WOMEN
Colon and Rectum

OBESITY
Tommy G. Thompson,SHHS
The National Press Club April 30, 2002 The National Press Club, Washington, D.C.

"300,000 Americans will die needlessly each yea from diseases and health conditions related to sedentary lifestyle or poor eating habits."

"17 MILLION AMERICANS HAVE DIABETES RIGHT NOW AND 16 MILLION MORE HAVE PRE-DIABETES. EACH YEAR NEARLY 200,000 WILL DIE FROM IT."
COST TO society 100 BILLION ANNUALLY

"61% of AMERICANS ARE OVERWEIGHT "
COST 117 BILLION ANNUALLY

Conclusion: OVERALL HEALTHCARE COST

ALCOHOL 166 BILLION
OBESITY 117 BILLION
DIABETES 100 BILLION
SMOKING 70 BILLION

I am NOT obese, and I do not drink even a drop of alcohol Stop punishing my personal choice.

And the Surgeon General Reports on smoking from Koop M.D. 1986 to Dr. Carbona M.D. 2006 shows second hand smoke studies under 2.0 (relative risk) according to FDA Robert Temple, director of drug evaluation "My basic rule is if the relative risk isn't at least 3 or 4, forget it."

Dr. Matthew Mintz said...

There is a HUGE difference between prescription nicontine inhalers and e-cigarettes. Nicotine inhalers are designed as smoking cessation aids, the have been proven in studies to be successful in helping patients stop smoking, they have been tested in many human subjects, and have been studied and approved by the FDA for safe use in the US.
E-cigarettes are not designed for smoking cessation. They are marketed as safe alternatives to smoking. In other words, the manufacturers want smokers to trade their tobacco cigarette addiction for a tobaccoless e-cigarette addicition. Though the lack of tobacco likely reduces many of the cancer risks of tobacco cigarettes and elimnates second hand smoke risks, the e-cigarettes have not been tested in humans, nor have they been approved by the FDA for safe use. Also, as mentioned in the orginal post, since data is not available and because of the way e-cigarettes deliver nicotine, it is possible that e-cigarette users will actually get more nicotine from e-cigs then from tobacco cigarettes, thus increasing risk for things like high blood pressure, heart attack and stroke; as well as making users even more addictive.

The argument that obesity and alcohol are bad, doesn't make smoking any less of a problem. That's like saying we are in a terrible economic crisis and involved in two wars, so health care in our country is not really something to worry about.

Anonymous said...

March 21, 2009

Dr. Mintz,

You have strong convictions about smoking and health. Did you know that the Surgeon General reports on involuntary exposure to smoke, known a SHS 1986 and 2006 were reported using QUESTIONNAIRES?
Questionnaires that asked participants was a room 20 years ago a little smoky, moderately smoky, or a lot smoky. 2006 Surgeon Report Page 16 Executive Summary states: "Questionnaires that assess exposures have been the primary tool used in epidemologic studies of secondhand smoke and disease. Page 15 Biomarkers can provide an indication of an exposure or POSSIBILY the dose, but for secondhand smoke they are used for recent exposure only. PAGE 15: "Sources of bias that can affect the findings of epidemilogic studies have been widely discussed both in general and in relation to studies of involuntary smoking. Concerns about bias apply to any study of an enviromental agent and disease risk: misclassification of exposures or outcomes, confounding effect modification, and proper selection of study participants." In the studies , factors that were not used were obesity, alcohol use, and occupation.

CANCER CAUSING AGENTS

Acetone Nail polish remover
Acetic Acid Vinegar
Ammonia Floor Cleaner
Toilet Cleaner
HAIR DYE AND BLEACH
Arsenic Poison, RAT
Cadmium Rechargable battery
Carbon Monoxide Car Exhaust Fumes
DDT/Dieldrin Insecticides
Ethanol Alcohol
Scotch Guard for
Carpets,upholstery
Formaldehyde Preserver-Body
Tissue and Fabric
CARPETS, DRAPES,
CLOTHES,car and air
seat cushions
Hexamine Barbeque Lighter
Hydrogen CyanideGas Chamber Poison
Methane ROCKET FUEL
AIRPLANE FUEL
Napthalene Mothballs
Nicotine Insecticide
Nitrobenzene Gasoline Additive
Nitron Oxide Disifectants
Pheonls
Steric Acid CANDLE WAX
"BODY LOTION"
Toulene HAIR DYE
Idustrial
Vinyle Chloride Make PVC2
Urethane Scotch Guard for
Carpets MINI WAX
for staining wood

METALS
Aluminum, Zinc, Magnesium,Gold, Silicon, (LEATHER CLEANERS) Mercury,Silver, Titanium,(PAINT), Lead, Copper (Cooking fumes)
More cancer causing agents:
Nitrosaminnes
Crysenes
Benso(a) pyrne
Poloniun
Nickel
P.A.H.'s
Dibenz Acidine
B-Napthylamine
N.Nitrosonomicotine
Toluidine
INTERIOR/EXTERIOR Sealer-Primer-stainblocker WARNING "This product contains chemicals known to the state of 'CALIFORNIA' to CAUSE cancer and birth defects,or other repoductive harm"

I report the above becaue cigarettes and e-cigarettes DO NOT HAVE SCIENTIFIC studies on the smoker or secondhand smoke that are accurate.I am a 57 year old female and cancer free. If I choose to take 5 to 7 years off my life according to the OFFICE ON SMOKING AND HEALTH (government controlled) that is MY CHOICE not the government or the FEW ANTI-ZEALOTS. According to the Freedom of Information Act I was able to find out just how many people expressed their concern for the smoking ban in VA. 83% AGAINST IT AND 63% FOR IT. Governor Kaine has refused to produce the e-mails, letters, or even the phone calls for or against the ban he signed into law. What happened to the majority of what the people want?????? Did Governor Kaine take any campaign money from the BIG PHARMS that will profit 46 Billion Dollars this year?
Do you contribute to the Robert Wood Johnson Foundation? RWJF(according to forces.org) was named after\the former head of Johnson&Johnson (J&J), the world's largest health and medical care products conglomerate, and the most of its wealth comes from J&J stock holdings, In 1992 to 1998 RWJF gave 126 million in grants,contracts,and programs to eradicate tobacco use in America. Americans for Nonsmokers Rights,(California?) was given grant money too. Do you receive any funding from RWJF?

To my knowledge, the FDA approved Nicotrol Inhalers according to the studies the pharaceutical company
provided them. You reference the FDA studies on Nicotrol Inhaler but not the references from the FDA. Could you provide the dates and references from the FDA studies for their approval of the Nicotrol Inhaler?

This past week, the news C-Span on the hill showed that the FDA is not capable of protecting Peanut Butter for our kids in this country. Also, cigarettes are NOT under FDA Regulation but a legal product sold in this country. E-cig also provide no-nicotine in their filters unlike the patch that delivers nicotine 24/7 into the blood stream that does not need a persciption to buy over the counter.

Perhaps I did not make myself clear about the 10% of the adult population suffering from the prevalent DISEASE of ALCOHOLISM in this country.(www.ahrq.gov) My references to alcohol and obesity was that they cost society 5 TIMES more than smoking yet no one raised their taxes to pay for the Health Care that President Obama plans to implement. I am paying higher health insurance premiums for the 46 milliom who do not pay and use the ER rooms for doctor visits and 80% alcohol related. Obesity is defined as 20 pounds above the standard weight charts. How about making those 66% adults ,the obese population.pay higer health insurance premiums? If you have a DUI or asssult charges (alcohol related) or blood alcohol level above the legal limit in the emergency room treatment which is documented and health insurances are aware. They
should pay higher insurance premiumns too. I call it dicrmiminstion when you go after one persons choice and not another.

I was not discussing the war in Iraq or Health Care Reform but since you brought it to my attention I will make a comment. How can we trust a government who knew about the AIG bonuses behind closed doors a month ago? Is Shep Smith not telling the truth when he said the White House, Congress, and the Senate met behind closed door a month ago. How about former President Bush, WMD in Iraq?

Your closing response about my argument on alcohol and obesity is clear. Do you think the obese population should also pay higher premiums? Do you think alcohol should be taxed in the same way cigarettes are taxed? When the government suceeds to abolish smoking who will then pay for the lost revenue in cigarette taxes that the federal and state collect?

Anonymous said...

Dr. Mintz,

You are absolutely right. Those of us who want to stop hurting ourselves and those around us should quit smoking. Easier said than done. In your perfect world, where your patients have perfect insurance and can afford the prescriptions you write out as fast as pen and hand can work and every page torn from your pad resonates in your head with "cha-ching," I am sure e-cigs are satan's toy and or a new ploy designed by the evil masterminds behind the largest cigarette companies to hook more users than ever before. How much do you earn from the companies for whom you write the most prescriptions? In reality, maybe your business is simply being threatened with the prospect of people switching to a process where one can start by using a high dosage of nicotine and continue to move to a lower dosage of nicotine until they have successfully weaned themselves off the nicotine completely, thus minimizing the need for your services. I am confident if this new product was called Advil and it was just coming out to allow consumers another, possibly better, alternative you would quickly jump to your soapbox and preach about the harms—all the while knowing that with every person you convince your income may go up. Why couldn’t you simply look at this concept from multiple angles like any good scientist would? Look at the good and look at the bad and then present the findings without slant. What are the possible benefits? There are FDA approved drugs out there that can aid with a condition, which may or may not be life threatening, yet have life threatening side effects. It is a matter of risk. Which is riskier: Smoke traditional cigarettes for a myriad of reasons or Smoke e-cigs for the same reasons yet stop taking into your body the cancer-causing chemicals found in traditional cigarettes. (Remember your oath)

Dr. Matthew Mintz said...

Anonymous #1- you are clearly a smoker that seems offended that as a physician I am against smoking.
Second hand smoke is a problem. Check out multiple facts and references at the American Lung association.
Though it is theoretically possible that e-cigarettes could be safe options for weaning of tobacco cigarettes, there is absolutely no data to support this. In fact, there is no data to support the safety of their intended use, which is to replace a tobacco cigarette habit with an e-cigarette habit. This is in contrast to FDA approved smoking cessation medications like the Nictrol inhaler than have been proven safe and effective in getting people off tobacco cigarettes. Here is the FDA approved package insert with the information you requested.
Again, bringing up the FDA's failure to protect peanut butter, alcoholism, or even the Iraq war are all moot points. All of these are bad, but that doesn't make smoking (the leading preventable cause of death in the US) any better. And yes, I do think we should tax alcohol higher and have some sort of a tax such that higher caloric, low nutrition foods are more expensive and healthy foods are cheaper. Currently, it is easier to buy a McDonald's value meal than fresh fruits and vegetables.
Anonymous #2- I don't live in perfect world and all my patients don't have insurance that covers smoking cessation prescriptions (though most FDA smoking cessation medications, even when paid for out of pocket, are cheaper then a pack of cigarettes a day).
Also, I am a salaried employee from a not for profit, large multi-specialty medical group. I make no extra money for writing prescriptions.

Anonymous said...

Dr. Mintz,

I think that your post is rather biased. Actually, I know so. But first, let it be known that I am a smoker and I have an e-cigarette. I can say that since I received my e-cigarette, I have cut back on my tobacco cigarette smoking by more than half without equally increasing my e-cigarette smoking. That to me indicates that it does help.

A peer reviewed study? Probably not. On humans? Again, probably not. Though, with the popularity growing, it seems there is quite the test sample. However, there have been lab studies on the e-cigarette cartridge to show that it is less harmful (from a chemical intake perspective) than tobacco cigarettes. [See Safety Report on the Ruyan® e-cigarette Cartridge and Inhaled Aerosol, Health New Zealand Ltd].

Now, on your bias... You site the WHO, "has called for the manufacturers of these products to stop making and promoting them". If you actually read the article that you link to, they only ask the manufacturers to stop marketing and promoting them as smoking cessation devices. Not to stop making them at all. That to me is clear bias on your part.

Now, I would love for studies (the proper kind in your mind) to be done and for the e-cigarette to be found at least safer/healthier than tobacco cigarettes. That would certainly make things easier. But at the same time, you cannot completely knock e-cigarettes. They are available in no nicotine strengths. Is that still "unsafe"? As a smoker, I can tell you that half the reason I smoke is the "hand to mouth" fixation; just the action of doing something with my hand. If I can have that and lose the harmful chemicals in tobacco cigarettes, great. If I can lose the nicotine too, even better. And, I working on that by stepping down with my e-cigarette.

Besides, with the bad things you've mentioned about nicotine, what about the potential benefits? Such DEcreased risk of Alzheimers? Or any other peer reviewed studies on some of the benefits of nicotine (mostly from tobacco cigarette).

In my mind, a doctor should not bias they're opinion on a topic that they don't have a vested interest in. You post indicates in many ways that you are biased against something you don't know about. Maybe what I expect from a doctor is different than most. But, I would at least prefer an opinion that includes some objectivity.

LaceyUnderall said...

Dr. Mintz,

Thank you for your interest in the electronic cigarette.

What I find extremely interesting is that you did not read our post at all, yet you felt the need to link to it. In your post, you state that somehow we are claiming the tests are not done on humans and done on mice. In our post, it clearly states that these tests have been done on mice and that a clinical trial on humans has been conducted and the data is being analyzed. http://www.e-cig.org/2009/01/16/clinical-trials-and-testing-of-the-electronic-cigarette/

I always find it curious when doctors can't find the e-cig as a great step towards tobacco harm reduction. The e-cig may not be proven to be 100% safe, but tobacco has been proven time and again to be deadly, yet it is available for purchase. Many of these tests have been done on mice.

The electronic cigarette is a smoking alternative. There are some of us who want to smoke. Just like there are some who choose to drink, over indulge in food, gambling AND shop their entire savings away on useless goods. We all have our "addictions" and as a doctor, I am surprised that you have not seen the positive aspects of this such as the lack of second hand smoke.

As far as FDA approval, we have all seen what that really means by the lack of oversight in this Peanut Butter fiasco. Our household was affected by ConAgra's salmonella outbreak two years ago when they led me to poison my child unknowingly! My child! Not myself but my child. Two years later, another company has done the same thing on a larger scale and that company had 12 tests in one year that came back positive for salmonella, yet they shipped their products anyways. http://www.cnn.com/2009/HEALTH/01/28/salmonella.outbreak/index.html It isn't China that is bad... it is bad people doing bad things and that happens right here in the USA.

One of the best things I ever did for my health was to stop taking pharmaceuticals. I certainly won't be trying Chantix which has led to people committing suicide in their sleep. And that's FDA approved? http://www.usrecallnews.com/2008/02/chanitx-and-suicide.html Even the scientists at the FDA are screaming of corruption and big business! Please, don't hide behind FDA approval. http://www.allgov.com/ViewNews/FDA__Scientists__Complain__to__Obama__about__Corruption__90112

But again, thank you! Every time a report is done and it is obvious the intentions are backed by the anti-smoking lobby or big pharmaceutical, smokers see right through it and purchase an e-cig. As an ex-smoker who smoked for 15 years, I haven't had tobacco cigarette in 3 months and I feel FABULOUS! And my doctor, thinks it is great!

Dr. Matthew Mintz said...

Lacey,
I did actually read the link. When something says that studies are underway, in my mind that means they haven't been done yet. I would not recommend a prescription or even supplement where studies on humans have not been completed and in the public domain.
E-cigarettes may be an alternative to tobacco cigarettes, but they are not clearly a safe alternative. Though tobacco cigarettes are clearly bad, since there is no human data available, I am concerned. In addition, nicotine is not in itself safe. We don't know the amounts of nicotine in e-cigs (another red flag), but the nicotine in smoking cessation medications are much less than the nicotine in cigarettes. Since they are designed, and proven effective for the purpose of smoking cessation, the risk (any medication has a risk) of the smoking cessation medications are likely worth the benefit of taking them. This is not necessarily the case of e-cigs.

Over-eating and gambling are also bad, and I don't recommend those either. Similarly, just because the FDA has messed up a few times, doesn't make the e-cigs safe.

For a young woman like yourself, it is great that you want to get off tobacco cigarettes. However, I would be very concerned about the potential high level of nicotine you are exposing yourself, especially if you view this as a cleaner habit. As someone interested in all things green, the e-cig is not really a very green product. Given that these are made in China, how do you think these products are made and who do you think is making them.

LaceyUnderall said...

Dr. Mintz,

I appreciate your response. What about the eLiquids that are made here in the US? Are they still in the same category for you as the ones made in China? (I don't mean this as harsh or offensive, simply looking for your opinion). Unfortunately, with the melamine and lead issues that came out of China, the Chinese have been demonized. Yes, what happened in those cases was a travesty. But if it weren't for the Chinese, well we wouldn't be typing back and forth :)

I, like you, definitely want to see more testing done. But the reality is that in order to do a long term study on the health effects, we would need to turn non-smokers into smokers. But I also am being realistic and in my 15 years of being a smoker and trying all of the pharmaceuticals you have suggested, I simply did not quit. I couldn't. Even after the nicotine was long gone from my system, I found myself even six months later, reaching for cigarettes. Not because of the nicotine, but because of the action.

Please. Take some more time to look into the e-cig. Please check out www.e-cigarette-forum.com where you will find a multitude of ecig smokers. They are open, honest and blunt. This product has worked for a lot of people and we all have shown improved health benefits. But the bottom line is... all of them are either off of tobacco completely OR have reduced their smoking from 2 packs a day to 5-6 tobacco cigarettes. That, is a step in the right direction.

Again, thank you for your time and I look forward to hearing what you might have to say in the future.

Dr. Matthew Mintz said...

Lacey,
I don't know what eLiquids are (not much on Google). I was not trying to insult the country of China or the Chinese people. My point was that since most eCigs are made in China, and China has many labor issues, especially child labor, I would suspect that eCigs may fall into this category (and surprised that a Green person like yourself would use these products on that basis alone).
I applaud your efforts to want to quit. You should know that most people require multiple quit attempts before they are successful. In addition, and agent used should be done in combination with some sort of counseling/behavior modification program. Your physician can do this, but there are other health care providers that are also capable. Tobacco settlements have also supported the 1 800 QUIT NOW quit line which gives you free 24/7 counselling.
I hope you will continue to try to quite all nicotine and tobacco products.
Though long term health studies would be interesting scientifically, what I would like to see is ANY human studies.
First, as used as cigarette replacement (the intended use), what are the levels of nicotine and what are there effects. Obviously, cigarettes are bad because of things besides nicotine, but nicotine itself can raise blood pressure, cause heart attacks, etc. A 12 week study in former smokers would be sufficient. No public data exists.
Secondly, I would want to see ANY data regarding e-cigs as a smoking cessation aid (not their intended use). I do not deny that they MAY have a role, but since they are not proven safe in humans, likely have too much nicotine to be effective for smoking cessation, and there are no studies suggesting that they do work for smoking cessation, I highly recommend against their use.
Finally, I would be highly suspect of the forum you mentioned. This forum is supported entirely by makers of e-cigs. I wouldn't even be so sure that all the posts in support of e-cigs are genuine users, and many may very well work for the companies that make e-cigs.

LaceyUnderall said...

Dr. Mintz,

I appreciate your concerns for child labor issues, but if that was your concern, then it should have been stated as such instead of implying that they are made in China and therefore "hard for federal agencies to regulate".

The forum started out with absolutely no sponsoring suppliers. It was made up entirely of ecig users simply sharing a community. What happened was "The Doctors" aired in the US and there were so many new members arriving every day, that the poor admin had to do something as his server kept crashing. There are very stringent rules for suppliers on how they can participate and believe me when I tell you this, there are many highly educated, self thinkers up there who will not let a supplier get away with anything off the cuff.

Again, all I ask is that you take some more time. If it is a 12 week study you are looking for, then maybe you could help me, help you get that study.

Brandon said...

Dr. Mintz,

Yesterday was the first day in 19 years that I didn't smoke a real cigarette. Would you recommend that I discard my e-cig and pick up a pack of Marlboro's? Honestly, I'm having a difficult time deciding which is worse, the evil I know, or the completely unknown.

As for nicotine content, I believe that my body absorbs more from a real cigarette than an electronic one. The last few days before I put away real cigarettes, I was smoking one per day. That one would give me a huge nicotine buzz. Fortunately I'm not 15 again, and the cool buzz didn't interest me enough to smoke another the next day. Anecdotally, the e-cig feels to deliver enough nicotine to stem the craving, but not as much as tobacco.

cedarwater said...

While I agree that the e cig may not be a safe alternative I feel that it's definitely a safer alternative. Having smoked a pack a day for 40 years the last 6 months have been the longest in that time that I have gone without tobacco.

Don't get me wrong ~ I quit many times. Once for a whole week ~ my son actually asked me to start smoking again or let him move to his grandmother's.

I have tried every way of quitting, some in conjunction with others. Nothing worked until the e cig. I can breathe well now and have no side effects.

I know the symptoms of nicotine overdose and while there were some in the beginning I know enough now to keep that from happening.
To me the e cig is a lifesaver.

Kamanjah said...

I find it interesting that you state nicotine raises blood pressure. Every time I have totally quit nicotine, I've had to start on blood pressure meds within 4-6 weeks to keep my BP in a normal range. Unfortunately, I was never able to stay off cigarettes, and every time I started smoking again, I had to stop the BP meds because my BP was dropping too low.

I haven't lit a cigarette since January 15 thanks to the e-cig. I'm still getting nicotine, I have absolutely no desire to light up and my BP is still normal.

I would gladly participate if someone would actually conduct a study of the effects of using an e-cig here in the US.

westcoast2 said...

Dr. Matthew Mintz wrote
"I highly recommend against their use."

I am somewhat confused by your position.

There are several issues intermingled. Quitting cigarettes, nicotine additction, use and safty concerns to name but a few.

It may be worthwhile trying to untangle some of these.

Quitting ciggarettes maybe your best advice, however are you saying it is quit or nrt? If so why? As you note, there are declining quit rates. There are those who do not wish to quit smoking and do not fare well on NRT, yet seem to do ok with e-cigs. Is your objection to e-cigs that people may enjoy them as an alternative, why is that a concern?

Nicotine 'addiction' has not been seen to be the major risk to health from cigarettes, the key risk being the tar content. E-cigs seem to have no tar issues and indeed contain a minimum number of chemicals. Surely this merits some further thought?

The reason given for smoking bans was the effect on other peoples health through 2nd hand smoke. Clearly SHS/ETS is not an issue, as you have said. so there seems to be no reason to ban them on these grounds, does there?.

Many things are not safe, yet are allowed, alcohol is the obvious example, so I am unclear on what basis you are making your objection. Is it perhaps the marketting?

You also say "Though the lack of actual tobacco in these products is theoretically better than cigarettes in some way, mainly decreasing the carcinogenic effect"

Decreasing the carcinogenic effect? Is this not good? Are you confusing a vaporizer with a combustable product? Is the name e-cigarette itself causing confusion? I am unclear why you use the term 'theoretically', could you explain?

You also say "Make no mistake: these products are not safe, in some ways could be riskier than cigarettes"

Do you have specific evidence that e-cigs are not safe or riskier than cigarettes? The fact that they have had limited testing does not of itself make something unsafe, does it?

Finaly, what about e-cigs that do not use nicotine, what are your concerns with these?

taz3cat said...

Dr.Mintz

I found NICOTROL INHALER, FDA APPROVED on the internet that have 10MG of pure Nicotine in their cartrages. The e-cigrettes liquid do not have pure nicotine in them. You reallly need to do a little more research before you make statements, like e-cigaretts have more nicotine in tham than NRT's.

I also suggest that you do some research Nicotine on PubMed, National library of Medicine. There are several publication my by reserchers on the benifits of Nicotine use. Since I am a balance person I will say there are some publications that show negative results for use of Niotine.

chantix, vioxx and several other drugs are shown to have negative and postive benifits also, But you just get dead quicker from some of the FDA approved drugs.

NRT's have some serious side effects for some folks also.

If congress has it's way the FDA will regulate tobacco and that means they approve of tobacco. Every product regulated by the FDA is approved or they ban it or make it illegal.That is really wonderful.

I don't understand why your worried about e-cigarettes in the first place. You haven't won the war on regular cigarettes yet and you won't.

If all else fails, our goverment will need to send troops to help keep the regular cigrettes from coming across Mexican border. It will be just a few hundred killed a year over regular cigarettes.

Anonymous said...

Dr. Mintz

Instead of worrying your double chin to death about the safety of E-cigarettes you may re-direct your concerns to the HUGH population that wants to legalize marijuana. I do not smoke marijuana but I will support the legalization because it is doctors like you that do not report the truth and meddle in peoples choices. California, the ANTI-SMOKING tobacco state allows possession, smoking, and growing marijuana; seems contradictory to me.

As an E-cig smoker my progress to the 0 nicotine filter has been accomplished. I now enjoy the oral habit of smoking without the use of tobacco and nicotine after 54 years of traditional use of smoking cigarettes.

Your blog thus far has received positive comments about E-cig including FDA reports that have approved the use of nicotine in gum, inhalers, and patches so what is your anti E-cigs about? Your personal opinion does not count. You contradict the pharmacutial companies who have the "big money ticket" to the sale of nicotine over the counter.

SHAME ON YOU!

Anonymous said...

From what I understand, an ecigarette cartridge contains propylene glycol and nicotine. Propylene glycol is FDA approved for use in food, cosmetics and medicines, and is listed as an additive in cigarettes at Phillip Morris's website.

It appears to me that this debate -reduced to it's simplest form - is about a device that allows smokers to mimic the act of smoking while inhaling two chemicals that are already widely used and approved by the FDA, elminates many other unhealty chemicals they are currently using on a daily basis, while totally eliminating the issue of second hand smoke.

I just don't see what the issue is here.

I have posted questions like this in similar forums and never gotten a response. Dr. Mintz, please clarify this situation for me.

Anonymous said...

I wrote the above previous post wanted to amend it slightly. I realize the FDA doesn't 'approve' tobacco products. I meant to imply that it is readily available. I also realize that tobacco isn't a chemical. Sorry..wrote that in a hurry.

I was thinking about the current debate regarding the ecigarettes since I wrote my previous post, and I belive it all comes down to semantics: The major issue seems to be that presenting this product as a means to quit smoking is not acceptable to many since it falls under the heading of a medical device, alhough the idea of it as a replacement for traditional cigarettes seems to be a problem for some as well. I suggest the marketers of the product simply offer it as a replacement and I think that the rest of us who do choose to quit will probably figure out the rest on our own since zero nicotine cartridges are available.

Seriously, do we not have bigger fish to fry in this country? Personally, I'd much rather see our legislators focusing on more immediate problems.

Anonymous said...

I posted the last two comments in this forum and it's been the better part of two days and I don't see any response to my question. Wonder why that is?

Dr. Matthew Mintz said...

I am glad to see that so many people have read this post, whether they agree with me or not. I am sorry for not responding sooner, but it has been a very busy week in both the clinic and the classroom.
There are certainly bigger fish to fry (war, uninsured) and there are certainly worse things to do then smoke e-cigarettes (tobacco cigarettes, heroin, murder). However, the purpose of my post was to warn patients and others about potential problems with e-cigarettes.
Taz3cat's comment exemplifies my concern with comparing the Nicotrol Inhaler to the e-cigarette. There are 3 big differences.
1. Nictrol inhaler has been tested in humans and determined to be safe for use in the US. E-cigarette has not.
2. Nictrol inhaler has been studied and shown to be an effective agent in quitting tobacco cigarettes (almost 3x better than placebo), the e-cigarette has not.
3. The Nictrol inhaler is a drug that is being properly regulated by the FDA, and can only be purchased in pharmacies with a prescription from a doctor. The e-cigarette IS a drug that is not being properly regulated by the FDA, because it can be bought in shopping malls in the US without a prescription.

My problem is that (in addition to improper regulation by the FDA) the e-cigarette is being marketed as a safe alternative to tobacco cigarettes and as an alternative to other smoking cessation agents and we don't know whether or not they are safe, and don't know whether or not they can be used effectively to help people quit.

I will acknowlege that e-cigs may be safe and may help people quite, but they may also be harmful, and until I see the studies showing otherwise, I would not recommend them. Given that they are designed to replace tobacco cigarettes, not get people to quit, I very much doubt that they will be effective agents in helping people quit. If proven safe, they may be a safer alternative to tobacco cigarettes, but it still would be advisable to quit e-cigs as well.
Lacey,
It's great that you are off tobacco cigarettes, but why not stop nicotine altogehter? Though nicotine is found naturally in tobacco plants, the nicotine in the e-cig is chemically produced and delivered in a plastic device with a battery. To me, that is pretty un-green. If you are really about all things green, and truly concerned about your health, then stop all nicotine use, including the e-cigarette. Here's a challenge specifically for you: If you can quit all forms of nicotine for a period of 12 weeks, I pledge to donate $100 to the green charity of your choice.

LaceyUnderall said...

Dr. Mintz -

This is the problem with doctors making statements without doing their research. The nicotine in eliquid is derived directly from the tobacco plant. It is not made in a lab somewhere by a pharmaceutical company.

And... you will be happy to note that I have actually eliminated the nicotine in my eliquid as of this week. I have no intentions of quitting the habit of smoking. So now, my electronic cigarette delivers me a dose of propylene glycol, distilled water and flavorings... all which are FDA approved for human consumption.

Can you believe it? And big pharm didn't get one dime of money.

Happy E-smoking my fellow smokers!

Kurt said...

Hi,

Just wanted to leave a comment after reading all the others here. I have not smoked traditional cigs since the start of this year with the help of the e-cig. I have failed several other attempts to quit. I do find that I actually like the e-cig and continue to use it. Severals reasons for this- cost, convienance, variety of flavors available, and the "perception" of decreased health risk. There does not seem to be any debate that it costs less to use, especially given the new taxes associated with tobacco purchases. Convenience- don't have to go outside any more. There are many flavors of the refill liquid to choose from, as well as zero nicotine content fluid. I guess that leaves me with my "perception". I have not found any convincing information that the e-cig is inharently bad; however, that does not guarantee it is safe either. (I suppose the people that used lead pipes in Rome so many years ago lacked that convincing information that it was a bad idea also) So I am left to consider it my own decision to continue to use it. I made the decision to smoke knowing full well it is bad for me, so the possibility of improving the situation seems very appealing. I also like the lack of second hand smoke and the missing variety of chemicals that are in traditional cigs. I would like for the product to be more extensively tested from a toxicolligy and extended use point of view. I would REALLY like to see certified product labeling on the refill liquid. At least then my decision to use it could be based more on substantiated research then "perception". I did have my physical done recently and requested my bloodwork to be done as well. I can't honestly tell you what 90% of the stuff meant on the blood test results, but every item was well within the normal range. Seems that there has not been any short term effects.

Anonymous said...

Wow. I'm surprised to see a doctor, who I thought was supposed to have a scientific, evidentiary type perspective, offer fully invented assertions such as "these products are not safe" and "these products will not be effective smoking cessation aids."

Perhaps the willingness to offer up assertions without evidence is the deal with the devil that provides tv appearances.

Rivky D said...

Dr. Mintz,
Merely by the Fact that Your Message is not clear and Precise that : You are Calling on all doctors and Health advocates to call for an immediate initiative of having E-Cigs Tested and Clinicly trialed is enough for me to Question Your Motives.

Anonymous said...

I have been smoking the RED DRAGON for over a month now and I am loving it! I can breath better and I even feel better. The RED DRAGON is the new 2 piece unit. No more messing around with drips and leaking carts. No more wondering when your atomizer will fail. The cart has a built in atomizer which is replaced every time you replace the cart. At less than $3 a cart it is half the price of regular cigs and I seem to be getting about 1 1/2 packs from each cart. The batteries last me about 6-8 hours also. I liked it so much that I became a distributor. They are assembled here in the states instead of being shipped in from over seas, so they do not have the problems with customs holding their inventory like most. They do run out of this or that from time to time, due to a huge demand, but they seem to get them back in stock very quickly. Their 8 piece kit is only 79.95 and that includes 2 batteries, 5 carts, a USB charger and a wall charger. They also have a 2 piece kit for 39.95 that comes with 1 battery and a USB charger. They carry over 20 flavors also. Check them out at www.buyreddragon.com/shop/ and use the code 297-684-432 to save 5%. They have a 1 year guarantee on the battery and have great customer service.

Anonymous said...

The not for profit company you are salaried by, do they receive any donations from tobacco companies, or companies that produce or promote smoking cessations items such as inhalers, patches, gum, etc.? I will continue to check back to see if you answer this question. Also, are there any organizations that they are affiliated with that receive donations from tobacco companies or company that produce or promote smoking cessations products.

Dr. Matthew Mintz said...

Rivky, yes, I am asking that all doctors, health advocates, and other concerned parties to call for an immediate initiative of having E-Cigs clinially tested in humans. I am sorry if this was not clear.
I will admit that I should have made it clear that when I stated "these products are not safe" and "these products will not be effective smoking cessation aids" that this was my strong belief and not medical fact. We have no way of knowing whether or not e-cigs are safe or effective smoking cessation aids because they have not been tested in humans in clinical trials. As a doctor, my resposibility is to the health of my patients and the public, and thus I recommend that these products not be used until safety has been established. In addition, I am concerned that they may not be safe, and particularly concerned that they are being marketed as smoking cessation aids when data from other studies not involving e-cigs would suggest that e-cigs will probably not be effective agents for smoking cessation. Finally, I am very concerned that the FDA has not regulated these products and they are available in shopping malls across the country.
Regarding the last post, I am not exactly sure what kind of conflict of interest you are implying. I work for a medical faculty practice which is not for profit. All revenue is from direct patient care and some rare donations from patients. Smoking is the leading preventable cause of death and I want all forms of it stopped in this country.

James said...

Regarding nicotine levels in e-cigarettes, when we spoke to Dr Murray Laugeson about the e-cigarettes he had tested he told us that they contained about 10% the amount of nicotine as an ordinary cigarette (http://www.ecigarettedirect.co.uk/interviews/murray-interview.html). His main concern was whether smokers would be sufficiently satisfied by e-cigarettes that contained so little nicotine.

I also find it interesting that you quote the American Lung Association. This orgnisation has received huge amounts of money (much of it indirectly via the Robert Wood Johnson foundation) from the pharmaceutical companies that manufacture smoking cessation aids recently show to be so ineffective at helping smokers to give up for more than 12 months. They are known for spending large amounts of money on their staff, cars investments e.t.c. - not an organisation I personally don't rate very highly. Nor do many academics - Professor Brad Radu said to us in a letter about those opposing the electronic cigarette (with particular emphasis on tobacco free kids):"...these anti-tobacco extremists will eventually be held partially responsible for the deaths of millions of uninformed smokers." (http://www.ecigarettedirect.co.uk/campaign/TFK-to-kill-millions.html)

Finally, I'd like to leave you with a quote from another expert we interviewed, David Sweanor, who has worked with numerous companies and organisations, including the International Union Against Cancer, World Health Organization, World Bank and the Pan American Health Organization, on the issue of tobacco harm reduction and has received many prizes for his work.

He told us: "If there is anyone who believes cigarettes are no more hazardous than e-cigarettes I’d recommend a remedial course in basic sciences." (http://www.ecigarettedirect.co.uk/interviews/david-sweanor-2.html)

Sheri said...

Score: Known deaths from Chantix due to suicide: 34 Known deaths from the use of e cigarettes: 0
Yet, you promote it and write prescriptions for it as you dismiss the use of electronic cigarettes. I am particularly intrigued by the studies of veterans with PTSD who were prescribed Chantix despite the knowledge that Chantix is particularly dangerous for those with mental illness like PTSD victims. Chantix obviously is a very profitable drug made by a company with very big pockets. As for continued use of other NRT's, many users of the gum, in particular, continue using it for many years and become addicted to it. Even President Obama continues to chew it three years after announcing his intention to quit smoking. You endorse this product, but you object to e cigarettes because people may continue using them. Why is it that BP is allowed to market their gum to children with flavorful choices like fruity flavors and cinnamon burst and no regulation, yet the anti-tobacco crowd cries foul when they see a smokeless product, already regulated with no sales to anyone under 18, offer a smokeless choice to adult consumers? The hypocrisy within the anti tobacco movement is blatantly obvious to any who examine its policies. This condemnation of e cigarettes is a perfect example of that.

Anonymous said...

Dr. Mintz,

I am new to the e-cigarette and so far, I have replaced half of the cigarettes I smoke with the e-cigarette (or personal vaporizer or PV). I have smoked for over 33 years now and I do not want to quit smoking, I just want to continue "smoking" with something that is safer (surely this can't be denied that it is safer than a cigarette).

Nicotine is a legal drug and as long as it is, why would anyone object to a method of delivery that is safer than the inhalation of multiple carcinogens?

I have a 10 year old daughter and I hope that she never chooses to try nicotine, but I can't be with her everywhere as she ages. My mother tried when she found out I smoked (at 14) to stop me. She couldn't and there is nothing she could have done other than strapping me to my bed and we all know that is illegal. If my daughter chooses to have nicotine, I would rather there be a safer choice for her to pick from other than a pack of cigarettes.

I understand the need for testing, but what if it is found to cause an increased heart rate and blood pressure? Nicotine is still a legal drug and these things are much less harmful than the cancers and COPD caused by cigarettes.

Why would anyone limit someone's choice to choose something that is less harmful while the killer cigarettes are all over the place? The FDA will probably soon be overseeing tobacco and the bill states they cannot ban tobacco products. Yet, they can ban the e-cig. There is something not right here. Can you see that?

There is hope though if the electronic cigarette is found to be a reduced risk tobacco product and my daughter will have the choice of something that won't take her breath away if she chooses this legal drug.

Anonymous said...

Dr. Mintz,

I will relate my story.

I'm a 50yrs old, and started smoking at 15. 35 years and I haven't been able to quit.

I have tried NRT but it doesn't work for various reasons.

The patches are awful, if I put one on my shoulder it causes intense pain all the way down my arm. They are also not cheaper than cigarettes.

The gum and lozenges make me nauseous, just like chewing tobacco does if I try that.

I'm not going to try chantix etc. due to side effects, and cost. They are also more expensive than cigarettes.

I researched e-cigs, and looked at the studies as slim as they are. I decide to try them.

Since I have completely given up cigarettes and use the e-cig.

The liquid is derived from tobacco, you can choose strength or how many milligrams of nicotine is contained per milliliter and as a 35 year smoker I can regulate my dosage just fine, I have been regulating my dosage with cigarettes for 35 years.

I would have to do the same regulation of my dosage with an inhaler, but it would cost an order of magnitude more. It would be quite easy to overdoes with an inhaler, just as it is with patches and gum (chew 3, apply 3 patches etc.

I am pretty aware of my dosage of nicotine.

E-cogs seem to me to deliver less nicotine then a cigarette per puff, unless you use the stronger nicotine liquids in them.

Since switching I can give a few observations. I now breathe much easier when walking, especially up hills (I walk my dog 4 miles a day), my sinuses are remarkably clearer. I no longer hear a rattling in my lungs when going to sleep. I no longer have morning migraines I sometimes got which are cigarette induced.

They may not be totally safe, and I do have concern for the unregulated nature of the liquid. I believe at least for now the risk is worth it as the benefits seem apparent and the cigarettes have noticeably harmed my health in an increasing manner as the years go by.

I would appreciate a little more thoughtful reporting, and honest observant research done.

As for you, while you might not recommend them, which is quite understandable. I would prefer not to hear unfounded blanket statements such as "they are not safe" or "they are nor safer than cigarettes" when this is not a known fact.

As of now I plan to try to reduce my nicotine dependence slowly using the e-cig, and it has been a much easier and cheaper way for me to do so as so far the e-cigs are costing me less than half of the approx $200 per month tobacco cigarettes cost me.

Anonymous said...

"There is now very good evidence and current guidelines recommend that EVERY smoker interested in quitting be offered medication..."
Excuse me? With a long term success rate of 7% or less (depending on the study), how can you possibly come to this conclusion! As for me, I've tried everything from hypnosis to meds, patches, gum and inhalers, and stilled smoked cigarettes with all it carcinogens, carbon monoxide, etc. E-cigs,with small amounts of nicotine in a liquid base did the job for me from day 1.

Sir, you owe it to the 400,000 people a year who die as smokers to evaluate this new technology before you pan it. Some doctors are doing just that and see e-cigs as the long overdue lifesaver it is, as do many smokers' personal physicians when they their patients on track to a tobacco free life.

Anonymous said...

Dr. Mintz -
I wouldn't disagree about more research for these products but I have tried to stop smoking for years. I started when I was 15 and I am now 56. This is the only product that really helped me get off tobacco. I can't speak for anyone else but I do know that tobacco has over 4,000 chemicals (most of which are dangerous). What you fail to see is that the nicotine cartridges and drops come in different strengths - from a high nicotine, medium and low concentration. If you'd like you can just smoke flavored juice minus the nicotine. It usually comes in a base of propylyne glycol or vegetable glycerine(which is the better alternative). I have already weighed the positive and negative of the e-cig and the positive won out.
Keep on Vapin'
Tom P.

Tom Pizzuti said...

Dr. Mintz -
I wouldn't disagree about more research for these products but I have tried to stop smoking for years. I started when I was 15 and I am now 56. This is the only product that really helped me get off tobacco. I can't speak for anyone else but I do know that tobacco has over 4,000 chemicals (most of which are dangerous). What you fail to see is that the nicotine cartridges and drops come in different strengths - from a high nicotine, medium and low concentration. If you'd like you can just smoke flavored juice minus the nicotine. It usually comes in a base of propylyne glycol or vegetable glycerine(which is the better alternative). I have already weighed the positive and negative of the e-cig and the positive won out.
Keep on Vapin'
Tom P.

Anonymous said...

Dr. Mintz -
I wouldn't disagree about more research for these products but I have tried to stop smoking for years. I started when I was 15 and I am now 56. This is the only product that really helped me get off tobacco. I can't speak for anyone else but I do know that tobacco has over 4,000 chemicals (most of which are dangerous). What you fail to see is that the nicotine cartridges and drops come in different strengths - from a high nicotine, medium and low concentration. If you'd like you can just smoke flavored juice minus the nicotine. It usually comes in a base of propylyne glycol or vegetable glycerine(which is the better alternative). I have already weighed the positive and negative of the e-cig and the positive won out.
Keep on Vapin'
Tom P.

Tom-Electroniccigarette said...

I recommend and encourage people not to waste any time if they are concidering an alternative smoking into helping them to quit smoking.Electronic cigarettes has helped me greatly to stop smoking tobacoo cigs,which is extremely harmful to your overall health. With over 4000 chemical compounds created by burning a cigarette with various toxins and carcinagins that is cancer causing. compared to an electronic cigarette which has no tobacco, 0 carginagines or toxins that is no risk to your health, it contains 99% water and 1 percent nicotin which can be addicting but not harmful. please make the right choice for yourself and for others.Think & Be Safe! www.CigElectronic.com

Palermo said...

Hello all,

It is interesting to me how some physicians (the minority) will knock the e-cig and always state the same: "There hasn't been enough testing done to ensure it is safe". There are however thousands of Physicians in the USA who are told by their patients that they have tried the gum, patches, inhalers, and DEADLY CHANTRIX, not to mention accupuncture, accupressuse, hypnotism, etc,,, with zero success. Finally with the advent of the e-cig, these patients were almost immediately able to curb traditional cigarette use. What do their physicians tell them? Typically they tell them theat they are not aware 100% of the content of the liquid however when they are shown by their patients how the device works, physicians usually tell the if it is helping them slow down or quit traditional cigarettes, even if there are some hazards within, the greater goal of slowing down drastically and or quitting can be achieved, then "GO FOR IT". These Physicians understand that the mases of traditional smokers out there really do want to quit, however a patch or a toll free number is not going to do the trick!! Why do you think even a large amounts of Physicians smoke?? They are aware of all the dangers first hand as well as all of the cessation methods and still smoke!! Doesn't that tell you something as to the addictive properties of cigarettes? In addition, we do not even know what is in cigarettes!! Why doesn't the FDA do their own study of traditional cigarettes?? I would love to see the outcome of that!! Would it surpise anyone if Tobacco companies spiked up nicotine dosages on purpose?? After all, they need to re-coup millions of dollars they have lost from litigation. The bottom line is that no one with a scientific education who is HONEST can truly say that a device which contains 2-3 drops of a solution which is on average 75% Propylene Glycol, can be as or more dangerous than traditional cigarettes!!! Although not tested, just from a toxicology and chemical viewpoint, it is impossible!!

Palermo said...

In addition, I ask that all users of electronic cigarettes to please discuss with your personal physician how the e-cig has worked for you, and I also think it is important to show your device to your Doctor as well.

Here is a typical formula (13 ingredient total)for electronic cigarettes that you can also show your Doctor:

Mint Flavor:
Vanilla Extract (12%)
3-methylcyclopentan-1,2 dione
(1.1%)
tetramethylpyrazine (1.8%)
acetylpyrazine (1.5%)
2-methylbutyraidehyde (0.3%)
tabanone (0.9%)
ethanol (5%)
2-Methyl butyric acid (0.8%)
menthol (1.8%)
alpha lonolel (1.3%)
menthone (1.3%)
rose oil (1.9%)
1,2- propylene glycol (68.4%)

Please make sure to also show your doctor how the e-cig dos not burn anything (there is ZERO combustion) and thus there is zero TAR going into your lungs!

KVM Switches said...

Hope this news will be gladful to people who like to smoking and may protect them for harms.

Anonymous said...

Dr.Mintz

I just have one question for you. Have you, or are you now getting any kind of funding froma pharma company that sell cessation aids or products?

This means on an advisory board, speaker, or any other roll where the check comes directly or indirectly from one of these companies?

ASH tried to hide theirs, as did all of the people involved in the FDA test that were made to make the e cigarette look worse than they were, including some of the NGO's and their mouthpieces that you listed for reference in the article you just posted and in your rebuttals in the comments sections.

Any quick search will show that even the scientist of the FDA state that the leadership is corrupt. Just do a search for "FDA Corruption" and take a gander.

Now, the e cig was first advertised as a smoking cessation product, but the FDA stopped that by stating that they were illegaly advertised, so the industry complied and started marketing them as an alternative, and now you and your kind are stating that they are trying to keep people hooked.

Simple math tells you that 20 ingredients that are already in tobacco cigarettes compared to over 4 k ingredients in tobacco is a much smarter choice. Do you need a remedial 3rd grade course in basic science?

Anonymous said...

I just want to say that I have read all on here and I am a smoker and ordered eciggs,and I went from about 1 1/2 pks a day to maybe 2-3..it has helped me greatly and there may not be an FDA approval,but if people would study these maybe the eciggs could get FDA approved.And if doctors are so concerned then they should be pushing for FDA approval or more studies. And what about the doctors that do smoke..wonder if they have bought the ecigg...it shouldnt be up to society if we can or cannot smoke rather it be traditionl ciggs or e ciggs...if there legal to buy then it should be our choice.Thats the problam with todays world we have no privacy and everyone thinks they can run our lives. It is what it is. Cant change it.

Anonymous said...

Electronic Cigarettes are much safer than real cigarettes so whats the problem?

Electronic Cigarette said...

While electronic cigarettes can't help you quit smoking, they are safer and a lot cheaper. Plus they don't smell bad, they don't stain the teeth and are generally healthier than tobacco cigarettes. Why are people ralying against them?

e cigarette reviews said...

I think this electronic cigars can help us rid of the bad habits and also the bad effects of smoking the traditional ones.

Andrea said...

Hmm. I quit by switching to an ecigarette without nicotine. I tried the gum and it screwed up my mouth and digestion for over a year. I was afraid of Chantix - have you seen the side effects? The only side effect of the ecig is occasional dry mouth. I can breathe better and thank god for this product every day. It boggles my mind that you could suggest this would not work as a smoking cessation tool. It is the only thing that has worked for me. I am nicotine free and feel way better than when I was smoking.

I wanted a cigarette the whole time I was taking the nicotine gum. This doesn't even contain nicotine and allowed me to quit just because it satisfies the hand to mouth urge and makes you feel as if you are smoking. It allows you to participate in activities where there will be smokers, at a bar, etc. I was never strong enough to not smoke in those situations before, and now I can.

Andrea said...

I haven't touched a cigarette since I got my ecigarette. I am using one without nicotine, and it has been the only thing to help me quit.

Nicotine gum caused dental problems and constant stomach problems. Have you seen the list of side effects for Chantix? I don't care what the medical community or FDA has to say on this. I would have died smoking without this. I can breathe fine now, and don't need even need asthma medicine anymore.

I don't think nicotine is the main reason people keep smoking. Nicotine withdrawal is no big deal......not having a cigarette to hold is the hard part.

Anonymous said...

Dr. Mintz,

I have to say that I am rather surprised that you have had the self control and good manners to entertain the foolishness of this disrespectful bunch of piss ants.

How nice that certain folks here who have read a few bits of information online believe that they will "educate you".

I agree with you that this product has not been properly tested, is NOT a cessation aid,and just may create more serious addiction. What it is, is rather a different means of obtaining the same addictive substance.

Personally I believe this e-cigarette will do to the current generation the very same thing that the cigarette manufacturers have done to us for years.

Stand your ground. Some of us intelligent and respectful people agree with you.

Cold Turkey

Electronic cigarettes said...

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Palermo said...

Interesting how Dr Mintz stopped replying to messages as soon as someone asked him if he received any type of funding from any anti tobacco groups or pharmaceutical companies which manufacture smoking cessation products either directly or indirectly.

If 10,000 smokers switched from regular cigarettes (proven killers) to e-cigs (not a single documented case of a user experiencing any harmfull effect) and shared this with their doctors, how many doctors would tell them to throw away their e-cig and start smoking regular cigarettes again?

I have personally dealt with one of the highest respected professors of toxicology in the world. This professor has over 60 years experience and prior to being retired used to be the go to person for most heads of state as well as the FDA. He has viewed the ingredients of the electronic cigarette liquid and his opinion was that ALL of the different types of liquid used in the cartidges are very safe. He personally recommended changing 2 ingredients to make them even safer, however what is currently being sold as long as the ingredients are up to US and or European standards when it comes to purity are relatively safe. Furthermore without question they are much safer than any type of "burned tobacco".

Palermo said...

Interesting how Dr Mintz stopped replying to messages as soon as someone asked him if he received any type of funding from any anti tobacco groups or pharmaceutical companies which manufacture smoking cessation products either directly or indirectly.

If 10,000 smokers switched from regular cigarettes (proven killers) to e-cigs (not a single documented case of a user experiencing any harmfull effect) and shared this with their doctors, how many doctors would tell them to throw away their e-cig and start smoking regular cigarettes again?

I have personally dealt with one of the highest respected professors of toxicology in the world. This professor has over 60 years experience and prior to being retired used to be the go to person for most heads of state as well as the FDA. He has viewed the ingredients of the electronic cigarette liquid and his opinion was that ALL of the different types of liquid used in the cartidges are very safe. He personally recommended changing 2 ingredients to make them even safer, however what is currently being sold as long as the ingredients are up to US and or European standards when it comes to purity are relatively safe. Furthermore without question they are much safer than any type of "burned tobacco".

Anonymous said...

Dr. Mintz,

I for one would love to see a human study on e-cigs. Maybe then it would prove they are far better than analog cigs.

I had smoked from 14 to 50 years old and switched to e-cigs a year and a half ago. I don't use any nicotine in my cigs and haven't since the start.

If it wasn't for these, I'd still be smoking. I tried everything else out there over the years and this was the only real solution.

Sam said...

Looks like there is/was a dialogue going on between you two. The only thing I have to say is that, lack of strong evidence in support of e-cig beneifts does not necessarily impliy its risks. Even if it is not as helpful as it is claimed to be, it is still MIGHT be a better option than the tobacco. All we can say is: we don't know. We don't know if it's riskier or less harmful. In theory it is less harmful. If you think it's risker, it's you who should support your argument, not those who see e-cig as a better replacement.

Anonymous said...

I would just like to know if the ingredients in the ecigs are harmful. I looked up methylcyclopentan as it is one of them and was not pleased. I smoke American Spirit because it is pure tobacco without chemical additives. I want to know it I should stick with the Am Spirits or switch to the ecigs as I am not wanting to quit.

Dr. Matthew Mintz said...

That's the problem with e-cigs. Unless they are regulated, there is no real true way to telling whether or not they are safer alternatives to smoking. They very well might be, but as a physician, I can't recommend them because I can't be 100% sure that this is the case. On the other hand, tobacco cigarettes are definitely harmful. Even if American Spirit claims they have no additives, smoking tobacco is harmful to your health. Thus, there is no real way to tell which is better or worse. The best thing to do is to stop smoking.

Anonymous said...

"The best thing to do is to stop smoking." ...and you suggest Chantix? Really? A drug linked to suicide? Well that's great for all us depressed smokers, isn't it? Or those nifty nicotine gum pieces? What an expensive waste of time those were. I've known a lot of smokers who've tried a lot of different things to quit, and have tried many myself. Which studies have shown these things to be effective? I seem to be reading (and observing, and experiencing) a LOT of the opposite. E cigs got me off smoking. Your article presents nothing but fearmongering bias, without any real potential threats presented, beyond potential for nicotine overdose (these things have been out for 8 years, 4 in North America, surely a case could be made for this actually occuring by now). Of the four (quite studied and used today) chemicals commonly contained in e cigs, are any known to cause actual harm in the type of dosage a vaper might consume? Nothing else has ever caused me to stop craving cigarettes, and until it appears likely that these are worse, they should be legal.

Dr. Matthew Mintz said...

On 10/24, a review by the US Food and Drug Administration (FDA) of 2 epidemiological studies evaluating the risk for neuropsychiatric adverse events associated with varenicline (Chantix, Pfizer) and nicotine replacement therapy suggests there is no difference between the 2 smoking cessation therapies. See link below. In addition to varenicline, there are multiple studies that have showed the medications about double the rate of quitting smoking.
Using e-cigs is not the same thing as quitting because you are still using nicotine. All forms of medication, including nicotine products such as the patch or gum, are meant to be stopped after a 3 month period of being off tobacco cigarettes. There is no study I am aware of that shows that e-cigarettes are effective in getting patients off all tobacco and nicotine products.
Using e-cigs instead of tobacco cigarettes may be a form of harm reduction. The reason I use "may" in the previous statement, and the reason I don't recommend e-cigs is because they are not regulated and have not been studied, other than by the manufacturers who make them. Maybe they are safe, maybe not. Some of the initial FDA studies suggest that the contents vary widely and many have harmful compounds in them.


http://www.fda.gov/Drugs/DrugSafety/ucm276737.htm

Electronic cigarette fan said...

Wow, fiery debate here. I don't know about all the health and carcinogenic issues but i do know that electronic cigarettes helped me to cut down drastically without all the frustrations and nicotine.

happyhousewife said...

Dr. Mintz,
I have been using an e cig for two months and switched as an informed client who had no intentions of quitting smoking. I was looking for an alternative that simply does not smell. I started out with the 24 mg smoke juice and I have not had a regular cigarette in 2 months. I smoked a pack of camel lights a day for twenty six years. I now take a total of 15 individual drags within a 24 hour period , this is about the same as one single cigarette. I have stepped down to the 18 mg smoke juice and plan to step down next month to a lower amount because my smoking has decreased by such a dramatic amount. I do not need the FDA to tell me that I am no longer coughing in the morning and I no longer need 5 pillows to prop myself up at night on in order to sleep. I will repeat, I had no interest in quitting. Now I simply have an interest in lowering my nicotine intake down to zero and enjoying the many flavors of smoke juice available because I seem to simply enjoy the act of smoking. In two months my health has improved sir. I no longer wheeze or breathe heavily, and my family no longer coughs as they did from exposure to my smoking. I would be glad to sign up for any study involving e-cigs because the use of this product has changed so many things in my life for the positive. I agree that the e cigarette industry should be regulated and there should be industry standards applied. I heavily researched the products that I use and they are NOT the ones from the tv or in the mall. I would be glad to share my experience and information with you on this matter. I am not here to flame your opinion, and I am not here to argue with anyone. I do however disagree with you on the fundamental issue that e cigarettes are a bad choice for a person who is looking for a realistic alternative to smoking. I went into this as an informed buyer, I researched the issue heavily and looked into quality control procedures and ingredients lists and passed over on many companies before I made my final choices on hardware and juice. As a result of my research I was satisfied with the choices I made. As with ANY product, people should research their purchase before they buy it. Especially if it is something you are going to be investing a fair amount of money in on equipment and consumable product. The products that I use are produced to FDA food safety standards and are made in the USA. This was an important issue for me when choosing the products that I now use. As a doctor I would hope that you understand that there are some people who cannot quit smoking. I have tried patches, gums, the nicotrol inhaler, chantix, and welbutrin. none of these methods worked for me at all in any capacity. The ONLY thing any of those methods did for me was contribute to horrible mood swings and attitude changes that my family should not have to and could not tolerate. My 10 year old at the time was begging me to smoke again. In the past two months I have actually lost weight due to successful dieting, I have the breath to be able to exercise now and my smoking has decreased 99%. I have experienced zero problems with mood or over eating. Again , if you are interested please contact me.

Anonymous said...

Dr. Mintz,


I read you blog and I am highy disapointed in the the false information you are feeding to the public. E cigs do not release a "water vapor" not even close. I would think an educated doctor would have the sense to find out what the vapor is before misinforming the public. E cig juice contains PG,VG,nicotine and flavor. Look at that I educated you. : ) I think you should hit the books tonight and come back with some real facts.

John Sirks said...

Dr. Mintz,

I find your review quite appalling. Its as if you have plugged your ears while screaming, "la, la, la, la, la" when people tell you how effective e-cigs are to stop smoking cigarettes.

You have taken the position of "quit or die". You falsely claim that there is not enough evidence to prove that e-cigs are safer than cigarettes. This type of ostrich mentality is prevalent among those that are funded by the pharmacutical Goliaths. Lets face the facts, you cannot support e-cigs since it conflicts with what Big Pharma is doing. This would directly jepordize your job. Their products are aimed at nicotine cessation. This is why Big Pharma is a big waste of time towards people who enjoy smoking.

The vast majority of smokers do NOT want to quit their addiction to nicotine. They just don't want to die a slow and expensive death in which cigarette smoking excells at. The quality of nicotine within e-cig juice is almost identical to the nicotine used in patches and gum. Extensive testing of nicotine found in those products have been documented in many papers and the results from those papers show that the nicotine used in those products are quite harmless.

The nicotine used in e-cigs is of the same caliber as used in nicotine patches and gum. No surprise here.

We already have more comprehensive
knowledge of the chemical constituents of electronic cigarettes than tobacco ones. By using gas chromatography mass
spectrometry we have identified extensively the contents of the vapor from e-cigarettes. The only thing that the FDA found that was even remotely questionable was tobacco-specific nitrosamines (TSNAs) and diethylene glycol.

What the FDA failed to provide was the comparison of the levels of TSNAs found in e-cigs towards other "approved" systems such as the patches and gum. The results from those tests proved beyond a shadow of a doubt that the level of TSNAs found in e-cigs were almost identical to those found in nicotine patches and gum. In other words, those readings from e-cigs were as dangerous as the Pharmacuetical nicotine products.

The nicotine from e-cigs is a non-issue. The discovery of diethylene glycol is problematic. When pharmaceutical grade propylene glycol is NOT used, contaminants such as diethylene glycol are sometimes found within lower grades of PG.

So the myth that e-cigs contain antifreeze is dispelled by scientific evidence.

All the components of e-cigs have been tested beyond belief and even though e-cigs have not been tested as thoroughly as other nicotine replacement therapies, the contents of e-cigs are identical in nature to those products themselves. As more and more tests become available, what we are finding is that e-cigs are just as harmful as nicotine patches and gum.

These findings make e-cigs at least 1000 times safer than cigarettes. For every one day that a smoker smokes, it would take at least 3 years on e-cigs to even come close to that damage. Since the human body repairs itself over time, the possible damage that e-cigs are capabale of doing is negligable.

As more information about the saftey of e-cigs becomes more prevailant, your reputation as a trustworthy doctor is declining.

Millions of people around the world are switching to e-cigs with unbelievable success. No adverse reactions to e-cigs has ever been recorded unless we talk about the quality of PG and the batteries that are used.

There is no way to scientifically say e-cigs are completely safe. On the other hand scientific analysis of e-cigs have proven empirically that they are no more harmful than nicotine patches or gum which are obviously safer than cigarettes themselves.

If the saftey of e-cigs is no more harmful than nicotine replacement therapy, then it goes without saying that the contents of e-cigs are safe for consumers who wish to stop cigarettes but are unwilling to stop their nicotine addiction.

Gabriel said...

Although I agree completely that electronic cigarettes aren't "healthy", I personally know a plethora of people that have used them to successfully quit smoking. And for those who only use vapor cigarettes now instead of smoking feel they are a much better alternative. These people are educated people who have used a number of smoking cessation products that didn't work for them.

They also highly reduce the risk of fires in home, they allow people to pay more attention to the road while vaping instead of lightin up, they allow people who would normally smoke around their kids to vape without producing second hand smoke... the list goes on and on.

And yes, I do agree that they aren't "healthy" by any means and yes they are addictive as they do contain nicotine, however when I tried to quit with patches and lozenges I would still smoke cigarettes. Since vaping I have not smoked a single cigarette in YEARS. The FDA will approve of children taking amphetamines, but they won't approve of smokers finding a safer alternative (and yes, safer).