There is a lot of discussion all over the world about a new chemical analysis of e-cigarette liquids that was presented in an article of a consumers magazine in France. The article titled “Pas si inoffensive, la cigarette électronique”, which means “not so innocent, the electronic cigarette” or “not so harmless, the electronic cigarette” was subsequently reproduced all over the world with titles like “E-cigarettes are as harmful as cigarettes and could cause cancer, claims study” (Daily Mail) or “Cancer from electronic cigarettes” (greek newspaper Espresso). Such titles came from the fact that the original French comment (it is a comment about the study, not a true presentation of the study) mentioned that some of the chemicals were found in amounts higher compared to tobacco cigarettes and this is a cause for major concern. There was no mention of the laboratory which performed the analysis, no mention on the methodology, no mention on the results in numbers. Is this called science?
Where the truth lies
Some more things about this “study” were revealed today. Some information about the methodology was released in a French website. They took 3-seconds puffs, once every 30 seconds. They did not tell us how many puffs they took overall. They provide no information about whether a tobacco cigarette was also tested. What seems strange is that between puffs they were aspirating air from the laboratory (instead of just inactivating the vacuum pump). Moreover, we have no information about what devices were tested. This is very important because not every device has the same liquid content or atomiser efficiency. And it is obvious that the devices were not tested by vapers in order to determine their efficiency and whether their protocol is representative of pragmatic use.
However, I will assume that the methodology was absolutely perfect and everything was done in a scientifically proper way. Today, the consumer journal released more information about the results, including the amounts of chemicals found. The results are SHOCKING, not because of the concern about the health of consumers but because it once again shows how a study can be mis-presented and how much fear and intimidation it has produced to the public (in particular to e-cigarette users) for almost no reason.
The same chemicals were tested in 12 brands of e-cigarettes in a study by Goniewicz and coworkers that was published earlier this year. So, nothing new was tested in the French study. More importantly, the results of the French study are almost identical to those of Goniewicz. Below is the table of the results of both analyses.
For nickel, the French study found 0.2-12 nanograms per 15 puffs. Goniewicz had found even more than that, however he also found that a pharmaceutical nicotine inhaler had 190 nanograms of nickel per cartridge! For chrome, the French study found 1.0-6.7 nanograms. However, they fail to report if that was hexavalent chromium (chromium VI), which is the only chromium form to have carcinogenic properties. Still, the tobacco cigarette may have up to 500 nanograms.
It is obvious that the amount of chemicals found in e-cigarette vapor is lower compared to tobacco by orders of magnitude (even if we accept that the methodology was perfect and the results are absolutely credible). Of course, I am not supporting that e-cigarettes are absolutely safe. We don’t know that yet, and most probably they cannot be as safe as clean air. However, there is no doubt that the potential risk is significantly lower. So, how can all these articles reproduce this study as something new and “revolutionary”?
The biggest problem with such articles is the intimidation of e-cigarette users. Every time such an article is published, there are vapers all over the world who throw away their e-cigarette devices and relapse to smoking. I have seen it happening to people I know, it is happening every time such “news” are reproduced with such impressive titles and without the slightestreservation from the writers. This French study in fact gives us no new information about the chemical composition of e-cigarette vapor and does not change in any way our knowledge about the potential risks of e-cigarette use and the benefits compared to smoking tobacco cigarettes. I cannot explain why worldwide media refer to this study as if it is the most important discovery about e-cigarettes.
On Saturday August 31, during the annual congress of the European Society of Cardiology, I will present a study about the immediate effects of e-cigarette use on coronary circulation (blood flow to the heart muscle). In that study I found that e-cigarette use had no adverse effects on coronary blood flow compared to an almost 30% reduction in blood flow caused by smoking tobacco cigarettes. This is a study that has never been done before, it provides completely new information about the effects of e-cigarette on the cardiovascular system, but certainly it does not mean that e-cigarettes cannot cause cardiovascular disease or heart attacks in the long-term. Similarly, simply the presence of some chemicals cannot be presented with titles like “E-cigarettes cause cancer” or anything similar. Scientists, consumer advocates and journalists should understand that this is a sensitive issue and that their reports and articles have a direct and immediate impact on the health of millions of people all over the world.
Dr Farsalinos is a researcher at Onassis Cardiac Surgery Center in Athens-Greece and at Medical Imaging Research Center, University Hospital Gathuisberg in Leuven-Belgium. He is actively involved in research on e-cigarettes’ safety and risk profile.