General A BU professor's CDC E-Cig Opinions! [EDITED]

[She-Hulk]

One professor at BUSPH, Dr. Michael Siegel, is accusing the CDC of what amounts to a vast conspiracy aimed at manipulating the American public by unfairly demonizing e-cigs. Siegel believes that E-Cigs are a safe path forward away from cigarettes which he believes are dangerous solely due to their combustible properties, despite ongoing research and suspicions of the vast majority of public health professionals that E-Cigs are no panacea, and that the jury is still out when it comes to the possibility that E-Cigs may also cause lung cancer and cardiovascular disease.


According to this blog,


http://tobaccoanalysis.blogspot.com/2015/04/cdc-is-running-dishonest-campaign.html),


run by Siegel, a professor at BUSPH, who has published 70 papers related to tobacco and has studied the issue for 25 years, has described the CDC conspiracy as:

“CDC's campaign involves lying, dishonesty, and massive deception”

Siegel has discussed his theory, somewhat more rationally, with the Wall St. Journal:

http://www.wsj.com/articles/michael-b-siegel-the-misbegotten-crusade-against-e-cigarettes-1424821708


Has Siegel been duped by slick Big Tobacco marketing of E-Cigs? Could it be that there is no conspiracy, that the CDC is, like most public health institutions, wrestling with policy and scant data on e-cigs? Siegel also attacks CDC head Tom Frieden, the American Heart Association and two democratic senators as well the campaign for Tobacco free Kids!, though places most of the blame at the CDC.


What Dr. Siegal Got Wrong (IMO):


1. The shift to e-cigarettes is already happening in a dramatic fashion. The general public already believes that e-cigarettes are safer than traditional cigarettes (and that they were invented to help people quit cigarettes). It is almost as though Siegal is concerned that the CDC is tarnishing the reputation of the e-cigs manufacturers, dismissing any discussion about the size, and unknown nature, of the public health hazard posed by e-cigs. In my estimation, there is no damage done by the CDC communicating to the general public and public health care professionals that the health effects of e-cigs are unknown at this point in time, and possibly could be harmful to people's health based on animal studies and the presence of nicotine which has recently been zeroed in on as a key culprit in the development of smoking-related cardiovascular disease.

Wouldn't it be lying *not* to tell consumers that there might well be serious health risks associated with e-cigarette use, especially for teenagers and their developing brains. Doesn't Siegal get that the job of the CDC is to evaluate possible new public health threats?, I guess he forgot it is the Centers for Disease Control and Prevention.


2. Siegel dismisses animals studies regarding the biologic effects of nicotine as not firm evidence of the effects of nicotine on the brain of e-cigarette users, especially teens. Yet, e-cigarette vapor apparently contains hundreds of chemicals, including much higher levels of formaldehyde a known human carcinogen, and may cause pulmonary disease, include cancer. Siegal is apparently assuming that because there isn’t the ‘tar’ of cigarettes that it is patently obvious that e-cigs are safer . . . and perhaps even going so far as insinuating that e-cigs are probably 100% safe. Nonetheless, some researchers believe that nicotine may play an integral role in the development of smoking-related cardiovascular disease.

Also, e-cigarette fluid is actually quite dangerous as it can poison children much more easily then a traditional cigarette, so there are public health issues of some import that Siegel brushes over. According to the New York Times:


These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.


Another article noted:


According to the National Institute of Dental and Craniofacial Research, e-cigarette vapor can contain propylene glycol, glycerine, formaldehyde, acetaldehyde, acrolein, toluene, nitrosamines, nickel, cadmium, aluminum, silicon and lead.


While the levels of the contents in the vapor are much lower than in conventional cigarettes, some of them have been shown to cause cancer.

Hmmm, the thing is that although the concentrations of carcinogens are unarguably lower in e-cigs, what if there is a synergistic effect greater than just a simple linear dose dependent effect? What if people use e-cigs much more frequently than cigarettes or if there are other biologic issues we don't understand yet?

3. While e-cigs may well prove to be saf-er than traditional cigarettes, that doesn’t mean that e-cigs are absolutely safe themselves and that they won’t constitute a massive public health problem in the future. Some folks might assume that the rate of lung cancer with e-cigs to be perhaps 1% of what it is traditional cigarettes, but what if it’s higher, maybe closer to 20%? The only way to know for sure is to do the study (which will be done over the coming decades), and yet Siegel is slamming the bias of caution while ignoring his own real bias in that he doesn’t acknowledge that the facts aren’t in yet. E-cig vapor isn’t 100% pure nicotine and water, it’s got a lot of chemicals in it, no doubt some which are produced by the vaporization process itself. It’s is an important regulatory issues for the a host of government agencies to look at, Siegel seems to throw caution to the wayside and believes that we have enough evidence in hand to decide that it isn't in the public's best interest to regulate e-cigarettes.


4. The only reason for Siegel’s attacks against the CDC and others is his concern that traditional cigarette smokers won’t switch to e-cigs, hence depriving them of a technology that would probably drastically decrease their risk of lung cancer. Yet, he provides no evidence that the popularity of e-cigs would be blunted, in fact, they are more popular than ever, and most reasonable people would conclude that the CDC is saying that we should proceed with caution and advocates for the regulation of e-cigs. I doubt that he could find one smoker in a thousand who thinks that e-cigs are as dangerous as cigarettes, most smokers probably are aware of what is being said about these products, their doctor probably encourages them to switch to e-cigs if they can't quit through other means. But new e-cigarettes consumers, especially teens and their parents need to know the truth, even if that means that the 50-pack-year smoker with poor decision making ability has an extra question regarding e-cigarettes for his doctor at the next visit.


5. Siegel claims that the CDC is massively deceiving the American public by classifying e-cigs as tobacco products because they don't contain "tobacco." Really?!? One thing that makes tobacco . . . well, tobacco, is that the plant produces nicotine which has various physical and psychological effects, and is extremely addictive.

It seems to me that Seagel is saying, "no, nicotine doesn't make it tobacco, tobacco is tobacco because of carcinogenic tar and e-cigs don't have the tar so we should clean-up their rep and call them nicotine delivery systems but not a tobacco product." Give me a break! If e-cigarettes weren't labeled as being tobacco products, some folks might not know that the e-cigs have nicotine, which is poisonous, especially in a liquid solution, and is addictive. Similar to how yogurt and cheese are dairy products, but not milk, allows consumers to know that cheese is a dairy product and comes from a cow.

If e-cigarettes aren't labelled as tobacco products, consumers might think that e-cigs aren't addictive, but just this cool smelling vapor. In past articles, Siegel has argued that e-cigarettes should have *more* nicotine in them to make them more appealing to smokers. Siegel might not know that there is concern that nicotine is carcinogenic and may cause cardiovascular disease in smokers.

6. Siegel is oblivious with regards to the policy issue at hand, i.e. that a series of decisions regarding the use/marketing/labeling of e-cigs will be made in the coming weeks, months and years. He used to work at the CDC, but now enjoys slamming the office he used to work at, though he doesn't seem the least bit cognizant of the health policy issues circling e-cigs, or care to discuss discuss regulatory issues very much beyond childproofing, the power of the heating element, and a couple of chemicals in e-cigarettes which he believes without proof are a safe product. He's focusing on trivial issues that he uses as proof that the CDC is evil, such as somebody at the CDC who said that it is *not* positive that teenagers switch from cigarettes to e-cigs.

Well, the CDC could be right in that starting to use e-cigarettes probably will have some ill effects of its own, and e-cigs do nothing to ameliorate nicotine craving. Obviously the CDC knows that e-cigs are perceived to be safer, but they're looking at the long game and realize that it will be harder to put the genie back in the bottle if ee-cigarettes aren't regulated.

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[Solara]

tl;dr =P

Already though there's been a worrisome increase of e-cig use among younger populations (school age/high school children). Tobacco and e-cig companies are using the same marketing techniques with e-cigs that they used with regular cigarettes, and it's dangerously effective. Though the literature requires more evidence, I think it's clear that e-cigs are nowhere near as dangerous as regular cigarettes, but there still remains dangers (there are some carcinogens, nicotine is still harmful, etc).

What we need is effective regulation that prevents the maximum amount of people from starting to use e-cigarettes, while having the maximum amount of smokers switch to using e-cigs **exclusively**. I'm not convinced that e-cigs will lead to massive declines in population smoking rates, but we will see how that pans out in the near future. Still, in the near term, we need to regulate e-cigs (not used in indoor spaces, etc). What really needs to be looked at is the price of e-cigs. Price is the single most determinant of tobacco use worldwide (taken from the WHO's statement that tax increases are the most effective way to reduce tobacco use). Interestingly enough, tobacco companies want e-cigs to be taxed heavily. It doesn't make as much money for them, and they're scared that it will erode the market for cigarettes. Generally the rule is, whatever the tobacco companies want (to increase smoking rates), do the opposite of that. Just some food for thought =P.

Here in California, we have a lot of work in tobacco control (particularly at UCSF), and a lot of the people here are very much for heavy regulation. I agree with that, but think the issue of taxation needs to be examined closely.

 

[She-Hulk]

Though the literature requires more evidence, I think it's clear that e-cigs are nowhere near as dangerous as regular cigarettes, but there still remains dangers (there are some carcinogens, nicotine is still harmful, etc).

Probably e-cigs are safer than regular cigarettes, (though that doesn't say much as cigarettes are already so harmful), there are tons of examples were the marketing go it wrong, including cigarettes which were promoted as being healthy. There is an anecdotal case of a 17 year old boy who died of lung cancer after smoking e-cigs exclusively, and that the tumors were "everywhere" in his lungs, doesn't prove causation at all, but the article said that the amount of formaldehyde in e-cigs is 15 times higher than in regular cigarettes. There are just so many examples of the counterintuitive thing being right in public health/epidemiology that only rigorous studies/review of epidemiological data will allow us to draw conclusions, IMO.

http://timesnewz24.com/news/40-e-ci...tim-after-teen-boy-dies-from-lung-cancer.html

How far into the lung does "vape" go/penetrate versus traditional cigarettes. There might be some physiological/epidemiological surprises with regards to e-cigs, not the first time something like that has happened.

tl;dr =P

Already though there's been a worrisome increase of e-cig use among younger populations (school age/high school children). Tobacco and e-cig companies are using the same marketing techniques with e-cigs that they used with regular cigarettes, and it's dangerously effective.

If local and federal government decided not to regulate e-cigs, and if e-cigs retained their sterling reputation, I could see a future where the vast majority of teenagers used e-cigs. The issue is that all the other chemicals might be carcinogenic (and nicotine might potentiate the activity of other carcinogens), and simply having a powerful addiction/craving might well adversely effect teenage brain development. Some studies show that e-cigs are a 'gateway' drug, http://www.forbes.com/sites/melanie...-be-a-gateway-drug-for-teenagers-experts-say/, though Siegel argued there isn't proof for that. Personally, I think that the jury is still out on that one.

What we need is effective regulation that prevents the maximum amount of people from starting to use e-cigarettes, while having the maximum amount of smokers switch to using e-cigs **exclusively**. I'm not convinced that e-cigs will lead to massive declines in population smoking rates, but we will see how that pans out in the near future.

Agreed. It would be interesting to know if e-cigs are offered as a first line choice for smoking cessation. Probably, there is very little good that would come from a teenager starting to use e-cigs for the first time, and potentially various aspects of their health could be put at risk. If tobacco companies use price, as you said, to push traditional cigarettes over e-cigs than I could easily see new teenage "vapers" not having enough money to buy new e-cigs, but still being heavily addicted to nicotine and hence deciding to use regular cigarettes in a pinch.

If there is proof that e-cigs are less carcinogenic than cigarettes by a significant amount (which might be hard to do given there are different types with different chemicals), then it might be worthwhile to advocate the FDA to ban cigarettes and force tobacco companies to "clean up their act" and sell only e-cigs. Nonetheless, e-cigs might well just be the lesser of two evils and their use should probably be discouraged as well, and consumers should know that the companies marketing for e-cigs may be misleading.

 

[backwardinduction]

I've done research on dual use of e-cigs and tobacco cigarettes by European teenagers, and I can tell you that my study found that it's a huge problem. There needs to be better regulation against use by young people because of the theorized gateway effect. After all a 15 year old probably isn't using them to quit traditional cigarettes.

 

[oceanhue]

Really sick of these BU trolls.

 

[She-Hulk]

Really sick of these BU trolls.

Folks are trying to have a serious discussion, e-cigs use in teens is up something like 50% in the past two years and the Siegel blog posts discussed came out in April of this year (which I found while googling about e-cigs).

So, please, don't derail this thread!

BTW, your Dr. Siegel (I assume you are/will be a BUSPH student as you obviously aren't in this thread to seriously discuss this topic), has advocated for higher nicotine levels in e-cigs and is adamant that the vast majority of the public health establishment is wrong about calling e-cigs 'tobacco products', a viewpoint I'm sure the tobacco companies would probably *love* as it would make regulation that much harder, and make marketing so much easier to shed the tobacco produce label.

I can understand a public health professor politely disagreeing with *colleagues* at the CDC, AHA, and other organizations, but not rabid ad hominem attacks that sole purpose seems to be to vilify people like Tom Frieden and entities like the CDC.

I can't help wonder if the proponents of e-cigs are funded by Big Tobacco.

 

[She-Hulk]

I've done research on dual use of e-cigs and tobacco cigarettes by European teenagers, and I can tell you that my study found that it's a huge problem. There needs to be better regulation against use by young people because of the theorized gateway effect. After all a 15 year old probably isn't using them to quit traditional cigarettes.

It seems that e-cig use is rising rapidly among both teen smokers and non-smokers. Certainly, there must be a sizable cohort of teens who start using e-cigs, become addicted to e-cigs/nicotine and then occasionally use cigarettes as well. It's probably hard to draw firm conclusions as we're sitting right in the middle of this accelerating trend. And although e-cigs are intended to help smokers quit, I can see a teen or adult using e-cigs to rationalize their less ongoing cigarette use by thinking, "well, I use my e-cigs 75% of the time, and regular cigarettes the rest of the time, so that helps me avoid a lot of the lung cancer risk."

 

[She-Hulk]

Siegel is at it again in a new post this Monday. He argue that because e-cigs are an effective anti-cessation treatment for smokers, that online sales and different flavoring should *not* be banned:

To reduce access to these products by banning online sales or eliminating all flavorings would likely cause significant public health harm by increasing smoking. These policies would undoubtedly inhibit smoking cessation.

http://tobaccoanalysis.blogspot.com/2015_04_01_archive.html

What Siegel fails to mention is that regulating e-cigs (keeping them out of the hands of kids) might well mean stopping online sales and stopping "flavorings" which Big Tobacco uses to specifically target kids. The Siegel approach relies upon some assumptions which might not be true such as:

1. Kids don't start using e-cigs without being a smoker to begin with and kids just use them infrequently.
2. E-cigs are safe.
3. Cigarettes cause lung cancer because of 'combustion' and so e-cigs are safe, and also not tobacco.

Well, the research isn't nearly in yet, and some shows that e-cig use among kids who are both smokers, and cigarette-naive, is skyrocketing. As for e-cigs being safe, Siegel could well be wrong on that account, though everybody agrees that e-cigs are probably safer that cigarettes. As far as combustion goes, some studies show that habitual pot smokers aren't at a higher risk of getting lung cancer when compared to even nonsmokers! There might be surprises ahead with regards lung cancer in e-cig users. It might amazingly be that nicotine in combination with a certain small amount/type of aerosolized carcinogens (such as formaldehyde) is needed for the vast majority of lung cancer cases, and that combustion alone is not enough and that e-cigs are able to cause lung cancer at appreciable rates as well. Who knows until the studies are done.

 

[Stories]

This topic is a bit off topic because the topic of this forum is Public Health Degrees. But I'll participate and keep it on track and civil. I've edited the thread title to be more accurate and less sensationalist.

So the argument boils down to three points:

1.) Does e-cigs help current cigarettes smokers quit?
2.) Does the smoking cessation qualities of e-cigs outweigh the number of teens/new smokers starting on e-cigs?
3.) Are new teens/new smokers starting on e-cigs that would not have otherwise started on traditional cigarettes/other tobacco?

We know that #1 is true. But we know nothing about numbers 2 and 3.

I don't know anything about vaporizors and e-cigs except they have really odd fruity smells whenever I see/smell someone using them, and I don't like inhaling anything into my own lungs. But if e-cigs is helping substantial numbers of people to quit smoking and we know for a fact there are less "bad things" in e-cigs--it seems like a nice tool for people to quit smoking. My guess is, these people using e-cigs may not quit using traditional methods (e.g. patches or gum), so this is another tool that is available.

I think we all agree that teens picking up this habit is not a good thing, but at least some of these folks were likely to smoke cigarettes, so getting them on e-cigs instead is likely better. Of course, we can never test the alternative since that counter factual doesn't and won't exist in the real world.

tl;dr: It's probably better for folks to smoke e-cigs than cigarettes, even if it still sucks that people are smoking e-cigs.

 

[She-Hulk]

So the argument boils down to three points:

1.) Does e-cigs help current cigarettes smokers quit?
2.) Does the smoking cessation qualities of e-cigs outweigh the number of teens/new smokers starting on e-cigs?
3.) Are new teens/new smokers starting on e-cigs that would not have otherwise started on traditional cigarettes/other tobacco?

We know that #1 is true. But we know nothing about numbers 2 and 3.

Stories is doing a good job mentioning some of the 'unknown knowns', things that we know are issues, but which we don't have answers or the studies haven't/can't be done, or we don't have good epidemiological data from which to draw conclusions.

Things We Know

1. E-Cigs help some people quit smoking traditional cigarettes. Yes, we know this, and we assume, with moderately good reason that this will lower the incidence of lung cancer diagnosis in these people.
2. E-Cigs contain nicotine a highly addictive substance, and some smokers use both E-Cigs and cigarettes.
3. E-Cig use is up something like 800% in recent years, and more teenagers are using E-Cigs.
4. There is a push to regulate E-Cigs as more people use them and they do have a number of chemicals in them.
5. Lung cancer will probably kill hundreds of millions of people globally in the coming decades, increasingly in developing countries like China. It might well be public health enemy number one.

Things We Wished We Knew Definitively

1. Do some teens start using E-Cigs, (whom wouldn't have otherwise used cigarettes) and become hooked and suffer the ill effects of E-Cigs (which we don't know).
2. The health effects of E-Cigs. Some E-Cigs have 15 times the amount of formaldehyde (a carcinogen) compared to traditional cigarettes, and may cause cancer. Even though E-Cigs are marketed as being "cleaner" compared to traditional cigarettes, some of this sounds similar traditional cigarette marketing techniques involving filters.
3. The effects of a powerful drug addiction (nicotine addiction) on the developing teenage brain is unknown.
4. Yes, traditional cigarettes cause lunger cancer, but perhaps we don't know the exact mechanism and synergy between carcinogenic compounds as much as we'd like as smoking pot *apparently*, according to some studies, doesn't increase the lung cancer risk nearly as much as smoking cigarettes.
5. Will E-Cig promotion 'blur' the ongoing smoking cessation efforts targeting teenagers?
6. How high with the prevalence of teenage E-Cig use go? If E-Cig develop a sterling reputation as being a very mild vice, what's the upper limit of saturation?

The Uknowns Uknowns

There could be curve balls with regards to the expected health effects of E-Cigs. One article mentioned that scientists are hesitant to jump on the E-Cig marketing campaign as E-Cigs have been found to produce a large number of "nano-particles", apparently more than traditional cigarette smoke (probably due to the high temperature of the heating element), and these nano particles have been linked to asthma, diabetes, heart disease and stroke. The FDA won't rule on the issue as, obviously, there are no longterm studies of e-Cig use. The marketing might be right, or it might be wrong.

http://www.inquisitr.com/2044355/e-...than-smoking-tobacco-but-are-they-the-future/

tl;dr: It's probably better for folks to smoke e-cigs than cigarettes, even if it still sucks that people are smoking e-cigs.

E-cigs could potentially save tens of millions, or even hundreds of millions of lives over the comings decades. For example, if the FDA and other global regulatory bodies said, "The cost of healthcare for lung cancer patients is too much of a societal burden, traditional cigarettes are banned and only E-Cigs will be allowed as a nicotine delivery system." I could actually see China doing this before the U.S., given how entrenched Big Tobacco is in the U.S.. In the end, this could only happen if both cigarettes and E-Cigs are more tightly regulated, who knows, some legislators might push for regulations requiring Tobacco companies to sell mostly E-Cigs, and increase this percentage until cigarettes are phased out. Some people view E-Cigs as a panacea for lung cancer associated smoking and are irritated by any criticism of E-Cigs, though we don't know the lung cancer and other health effects of E-Cigs . . .

 

[She-Hulk]

2.) Does the smoking cessation qualities of e-cigs outweigh the number of teens/new smokers starting on e-cigs?

It is an interesting question, IMHO, from an academic standpoint only and wouldn't be used to effect policy decisions. If there is an absolute risk of lung cancer, heart disease, or other long health effects from e-Cigs, (I wouldn't be surprised), then the FDA, CDC and others will try to limit e-Cig use among teens. Just saying that regulatory bodies don't often weigh the lesser of two evils in terms of anything (from dangerous infant car seats to Listeria contaminated ice cream), and they won't knowingly promote something that they known will cause morbidity and mortality for teens. Though of course the FDA/CDC and others can do the studies and come to conclusions, such as saying that e-Cigs are less hazardous than regular cigarettes (maybe by 75%), there is a special moral obligation to make sure that teenagers aren't hooked on e-Cigs when the longterm effects and "gateway" shifts to and from regular cigarettes isn't known.

There is a compelling 'harm reduction' case to be made, but all of the evidence isn't in yet, and that make take 5-10 years. If E-Cigs prove to cause heart disease, lung cancer at reduced but moderate rates when compared to regular cigarettes, and/or if folks who get hooked on E-Cigs migrate back and forth to regular cigarettes, then there is little reason to turn a blind eye to E-Cigs and regulation will become increasingly important.

 

[Stories]

It is an interesting question, IMHO, from an academic standpoint only and wouldn't be used to effect policy decisions. If there is an absolute risk of lung cancer, heart disease, or other long health effects from e-Cigs, (I wouldn't be surprised), then the FDA, CDC and others will try to limit e-Cig use among teens. Just saying that regulatory bodies don't often weigh the lesser of two evils in terms of anything (from dangerous infant car seats to Listeria contaminated ice cream), and they won't knowingly promote something that they known will cause morbidity and mortality for teens. Though of course the FDA/CDC and others can do the studies and come to conclusions, such as saying that e-Cigs are less hazardous than regular cigarettes (maybe by 75%), there is a special moral obligation to make sure that teenagers aren't hooked on e-Cigs when the longterm effects and "gateway" shifts to and from regular cigarettes isn't known.

There is a compelling 'harm reduction' case to be made, but all of the evidence isn't in yet, and that make take 5-10 years. If E-Cigs prove to cause heart disease, lung cancer at reduced but moderate rates when compared to regular cigarettes, and/or if folks who get hooked on E-Cigs migrate back and forth to regular cigarettes, then there is little reason to turn a blind eye to E-Cigs and regulation will become increasingly important.

I think one of the most interesting questions is--as you alluded to in a previous post, if the other known co-morbidities associated with tobacco smoking/chewing will also reveal themselves in vaping/e-cigs. One reason for optimism--marijuana smoking is not associated with lung cancer (a well designed meta-analysis: http://onlinelibrary.wiley.com/doi/10.1002/ijc.29036/abstract) and many other diseases which gives some hope that the potential nanoparticles, VOC, and PAH found in smoke/vapor may have "acceptable" health risk--particularly compared to the alternative of tobacco cigarettes. The heating and close proximity of lung inhalation may have similar effects on the lungs, but this will need to be closely monitored.

I think your comment about China regulating tobacco is an interesting one: my guess is not. For one reason: the tobacco industry is government controlled.

 

[She-Hulk]

I think one of the most interesting questions is--as you alluded to in a previous post, if the other known co-morbidities associated with tobacco smoking/chewing will also reveal themselves in vaping/e-cigs. One reason for optimism--marijuana smoking is not associated with lung cancer (a well designed meta-analysis: http://onlinelibrary.wiley.com/doi/10.1002/ijc.29036/abstract) and many other diseases which gives some hope that the potential nanoparticles, VOC, and PAH found in smoke/vapor may have "acceptable" health risk--particularly compared to the alternative of tobacco cigarettes. The heating and close proximity of lung inhalation may have similar effects on the lungs, but this will need to be closely monitored.

I think your comment about China regulating tobacco is an interesting one: my guess is not. For one reason: the tobacco industry is government controlled.

The finding regarding marijuana smoke is good for those using cannabais. However, one article I read, http://www.leafscience.com/2014/06/27/marijuana-doesntgaincrease-lung-cancer-risk/, said that marijuana smoking deposits *four times* the amount of tar as cigarettes in the lungs, if true then it might be possible that the "tar" from smoking either marijuana or cigarettes is not by itself causal in terms of get lung cancer. Know of a chemical/carcinogen that is in cigarettes but not marijuana? Is it possible that nicotine acts in synergy with other "tar"/carcinogens and potentiates their effects on lung tissue, hence . . . the finding of no association between lung cancer and longtime pot users may be actually really bad news for E-Cigs users.

I think it is simplistic for the blog to say, basically, combustion = "bad"/lung cancer and E-Cigs don't combust, therefore no lung cancer. Well, marijuana joints are certainly combusted, and given they are plant material that probably produces a similar tar/combustion products as tobacco leaves, that sort of reasoning seems to be simplistic. I'm not an expert on the issue, but the basic disease process whereby cigarettes can produce lung cancer may be multi-stepped and dependent on nicotine.

Some people think that nicotine in cigarettes is the primary reason why cigarettes increase the risk of cardiovascular disease:

http://www.sciencedaily.com/releases/2007/09/070913084429.htm

If so, E-Cigs may cause a lot of cardiovascular disease, and the lung cancer risk is unsettled.

 

[She-Hulk]

I think your comment about China regulating tobacco is an interesting one: my guess is not. For one reason: the tobacco industry is government controlled.

Just about everything in China is government controlled to one extent or another, and the Chinese government can change its mind and decide to regulate something that they didn't dabble in beforehand, but the situation in China is different:

1. China is home to 1/3 of the world's smokers, about 300 million, there are about 45 million smokers in the U.S..
2. The smoking rate in China is 25%, the U.S. smoking rate has fallen from about 42% to about 21% of the adult population since the 1960s to the present. Currently, the CDC says that 17.8% of Americans smoke.
3. The people in China who control the production of tobacco are also in charge of tobacco control and prevention efforts.

Societal changes in China start at the top and go down, a "top-bottom" approach, so if the Chinese leaders decide that the evidence favors E-Cigs over cigarettes, then they could simply legislate this change, make regular cigarettes illegal. This is a big "if" as preventing dissent and revolution means keeping the population happy and not taking away the things they like, like cigarettes. Nonetheless, the Chinese could mandate that shops sell equal amounts of E-Cigs and cigarettes and that they make the change slowly overtime, though there might be a black-market for cigarettes.

http://www.usnews.com/opinion/blogs...cco-advertising-ban-in-effort-to-curb-smoking

The top folks in China will at some point realize that the data show that since 1999 the tobacco industry in China is a net negative, in terms of healthcare costs, and they may decide that a change is needed. The Chinese government could even help defray the cost E-Cigs if they reasoned it would help ever increasing medical bills for lung cancer patients.

 

[Stories]

I think the nicotine angle is very interesting. There's been some good research done in this avenue, but I think here's the good news. Nicotine is associated with vessel constriction, but the safety of nicotine delivery mechanisms (i.e. patches) seems to be fairly high and not associated with cardiovascular events, overall (the results of a meta-analysis including 63 studies: http://circ.ahajournals.org/content/129/1/28.full). "Tar" is also very heterogeneous. We don't know if the "tar" in marijuana, cigarettes, and e-cigs are all the same. So that definitely warrants some discussion. I think what we need to really investigate about e-cigs is what are the components of the vapor and with the mode of exposure, what amount of risk does it pose? Should they be regulated more like tobacco or alcohol or something else?

Just about everything in China is government controlled to one extent or another, and the Chinese government can change its mind and decide to regulate something that they didn't dabble in beforehand, but the situation in China is different:

1. China is home to 1/3 of the world's smokers, about 300 million, there are about 45 million smokers in the U.S..
2. The smoking rate in China is 25%, the U.S. smoking rate has fallen from about 42% to about 21% of the adult population since the 1960s to the present. Currently, the CDC says that 17.8% of Americans smoke.
3. The people in China who control the production of tobacco are also in charge of tobacco control and prevention efforts.

Societal changes in China start at the top and go down, a "top-bottom" approach, so if the Chinese leaders decide that the evidence favors E-Cigs over cigarettes, then they could simply legislate this change, make regular cigarettes illegal. This is a big "if" as preventing dissent and revolution means keeping the population happy and not taking away the things they like, like cigarettes. Nonetheless, the Chinese could mandate that shops sell equal amounts of E-Cigs and cigarettes and that they make the change slowly overtime, though there might be a black-market for cigarettes.

http://www.usnews.com/opinion/blogs...cco-advertising-ban-in-effort-to-curb-smoking

The top folks in China will at some point realize that the data show that since 1999 the tobacco industry in China is a net negative, in terms of healthcare costs, and they may decide that a change is needed. The Chinese government could even help defray the cost E-Cigs if they reasoned it would help ever increasing medical bills for lung cancer patients.

Ambient air pollution in China also contributes substantially to their healthcare expenditures, but we know where that is currently. As of now, China's current priority is still with economic development and less with individual citizen life and health. This will eventually have to change as the Chinese population ages. The smoking rate among males in China, though, is over 40% and in some subgroups (middle aged 40-60 year olds) is over 60%. Eventually, they'll see the effects of smoking and ambient air pollution together to see sky rocketing CVD (they've already seen increased rates across the board). But as I said, they still have a ways to go to make this a priority in the country. Also, half of China lives in rural areas--while changes in the urban areas can be accomplished relatively easily, reaching out to the rural areas is much more difficult where things like inadequate home ventilation (e.g. homes that burn biomass for heating and cooking indoors) is a bigger respiratory and cardiovascular risk factor that affects more people directly than tobacco.

I think one of the problems with things like controlled substances is this--in the end, it's people and they have choices. They'll do what they want to do. Government policy and community outreach be damned. Regulations will be made, and product manufacturers will change their products to meet regulations. Their products will still end up in the hands of consumers. See the plateaued % of smokers in the US despite the millions thrown at anti-tobacco efforts. And funny enough, the tax revenue that we get from smokers funds many health programs. So many smokers benefit lots of others in the end. It's just a funny story all around that has some benefits! Go figure.

 

[nutella_lover]

GODDDDD I can't with the BU TROLLLLSSS

@She-Hulk you never answered who you are and why you care? You would never know this stuff if you were actually a prospective student --> you're holding court with a member who works in biotec epi and has a PHD!!!!

get real and get a life; some people actual enjoy Mike Siegel and find him provocative. It is a blog after all, not a published paper.

 

[She-Hulk]

I think the nicotine angle is very interesting. There's been some good research done in this avenue, but I think here's the good news. Nicotine is associated with vessel constriction, but the safety of nicotine delivery mechanisms (i.e. patches) seems to be fairly high and not associated with cardiovascular events, overall (the results of a meta-analysis including 63 studies: http://circ.ahajournals.org/content/129/1/28.full).

I don't know as much as Stories with regards to nicotine, just found this article in CNN though regarding specific effects of nicotine on the cardiovascular system:

http://www.cnn.com/2013/12/16/health/nicotine-e-cigarettes/

and some scientists report that despite nicotine patches appearing to be safe, nicotine might be responsible for cardiovascular disease:

http://www.browndailyherald.com/2012/03/09/nicotine-itself-may-threaten-cardiovascular-health/

The article that Stories quotes actually revealed that "there was an elevated risk associated with nicotine replacement therapy that was driven predominantly by less serious events", and the more serious stuff the metanalysis looked at was heart attacks (fatal and nonfatal) and strokes (fatal and nonfatal) was not increased with nicotine replacement.

One possible explanation is that it takes many years for smokers to develop cardiovascular disease to the point where they'll have a stroke/heart attack, and perhaps most studies of nicotine patches are more short term. The article actually was specifically looking at the safety of nicotine patches (and other smoking cessation methods) within the quiting period. (Which I take to be less than a year). Anyway, the studies are probably hard to interpret because 99% of folks on nicotine patches are probably past smokers anyway . . . you couldn't ethically start some people on nicotine patches just for a study and see what happens, no?

The study said they excluded smokers with a history of cardiovascular disease, but that just means known cardiovascular disease, their arteries might probably have undetected damage, so both groups being studied probably had a lot of cardiovascular damage, they just didn't have a heart attack. I think this study was done to make people feel safe about using nicotine patches for a cessation period, and they appear to be when compared to smoking, but that doesn't say a lot about whether nicotine causes cardiovascular disease, which is a long term process.

She-Hulk's Bottom-Line: The metanalysis wasn't designed to answer the question of whether nicotine in cigarette smoke causes cardiovascular disease, though in the short-term nicotine replacement for smoking cessation probably just causes mild cardiovascular disease symptoms (within the quiting period of probably around six months), but not a heart attack or stroke above or beyond where the ex-smoker already is physiologically.

 

[She-Hulk]

. . .

 

[She-Hulk]

. . .

 

[She-Hulk]

. . .

 

[She-Hulk]

"Tar" is also very heterogeneous. We don't know if the "tar" in marijuana, cigarettes, and e-cigs are all the same. So that definitely warrants some discussion. I think what we need to really investigate about e-cigs is what are the components of the vapor and with the mode of exposure, what amount of risk does it pose? Should they be regulated more like tobacco or alcohol or something else?

I'd assume much of the "tar" in pot and tobacco plants to be similar, after all, most of it will be the combustion of plant substances mostly similar to plants in general. Nicotine is 0.6% to 3.0% the dry weight of the tobacco leaf . . . that's actually lot! Tobacco plants are cultivated specifically to increase the content of nicotine in their leaves. Remember that all plants need certain things to survive, like chloroplasts, and cellulose cell walls, and DNA . . . not a lot of differences between the two plants with the stuff conserved among plants. I'm guessing that the biggest chemical difference between pot and tobacco is that one is cultivated specifically to produce THC and the other nicotine. The genetic differences between humans and chimps is something like just 1%, I'm guessing its the same with tobacco and marijuana plants, meaning the composition of the tar is likely quite similar (the big difference being THC/nicotine in the smoke).

A lot of hay has been made regarding why pot smoke is apparently close to being non-carcinogenic in terms of lung cancer, from everything from how pot is supposedly not packaged tightly when compared to cigarettes to perhaps pot smoker don't smoke pot as frequently during the day as cigarettes smokers even though they inhale deeply. What if nicotine is the reason for this difference? If nicotine is proven to be integral to lunger cancer and/or cardiovascular disease, it would mean more impetus for regulation of e-cigs.

But, yes, assuming the data regarding the apparent lack of risk of lung cancer in marijuana users is real, then either the "tar" (a very vague general term that includes everything in the smoke perhaps beside the simple components, I'm not an expert) of marijuana and tobacco are very different in small ways, or it is due to the nicotine, (or less likely a protective effect of THC).

 

[Stories]

But, yes, assuming the data regarding the apparent lack of risk of lung cancer in marijuana users is real, then either the "tar" (a very vague general term that includes everything in the smoke perhaps beside the simple components, I'm not an expert) of marijuana and tobacco are very different in small ways, or it is due to the nicotine, (or less likely a protective effect of THC).

My gut is to go more with the results from the meta-analysis because it is an aggregate representation of all the literature out there (it's 63 studies), so any outlier studies or opinions get more or less washed out. The minor CVD events were tachycardia which to the FDA is a relatively minor event of little consequence. But remember--if alternative to these methods of cessation is smoking.

Both of the articles you mentioned were works that presented at conferences--there's relatively little vetting of results and abstracts prior to presentation and there may be substantial flaws in their design and results. Of works that are published, a substantial number are never replicated. The paper presented at the conference by Chi-Ming Hai is as of now unpublished (both links are about the same study). Regardless, the project was basically exposing cardiac cells to e-cig vapor showing signs of cellular motility. Remember, however, that the route of exposure for e-cigs is through inhalation and that once inhaled into the body, will undergo metabolism and become various metabolites that are (likely) less reactive. Additionally, the dosing of the nicotine in vivo compared to an in vitro study will be substantially (magnitudes) lower.

I have conducted several studies in lung cancer via the inhalation pathway in China, and "tar" is not the same between brands, smoking device, and region. Remember--the additives in cigarettes between cigarette companies is proprietary and heterogeneous. What you get from one brand to another, plus what you get from country to country, is also different.

As of now, I think it's best to keep a skeptical eye on e-cigs, but understand that it has its place as a cessation tool. But, remember, the key carcinogens in e-cigs have been (mostly) eliminated and the levels of addictive substances are greatly reduced (nicotine), as would be expected of a cessation tool.

Re: Michael Siegel, he has strong opinions and he's not a "traditionalist" on the social-behavioral end of research. What he's suggested in his work is that traditional forms of health education (i.e. "educate, inform, make decisions") does not work as effectively as getting into people's heads and getting at what makes them tick. He thinks the tobacco "Truth" campaigns were particularly effective because it wasn't just a simple "inform, change behavior" type of campaign but was trying to get at the cultural aspects of teenage smoking. My guess is here he's thinking that taking away a tool that has been shown to be effective at tobacco cessation is fool hardy. If you put these tools out of reach--people reach for alternatives--ones we'd prefer people don't go for.

 

[She-Hulk]

My gut is to go more with the results from the meta-analysis because it is an aggregate representation of all the literature out there (it's 63 studies), so any outlier studies or opinions get more or less washed out. The minor CVD events were tachycardia which to the FDA is a relatively minor event of little consequence. But remember--if alternative to these methods of cessation is smoking.

The said meta-analysis doesn't come even close to answering the question of whether nicotine in cigarette smoke is integral to causing lung cancer, for two big reasons:

1. Cigarette smoking and lung cancer causation is a longterm process, different from a 12-week smoking cessation trial of nicotine patches. One article I found acknowledges that the longterm safety effects of nicotine patches is unknown, i.e. for smoker with a high risk of relapse who is placed on nicotine patches for years.

http://cancerpreventionresearch.aacrjournals.org/content/4/11/1719.full

2. Smoking delivers the nicotine in high concentration to the *lungs*, of course nicotine in nicotine patches achieves a much lower dose exposure in the lung tissue, so you're really comparing apples and oranges.

I think most people involved in lung cancer research would agree that a short-term study of nicotine replacement patches does little to answer the question about smoking and lung cancer. I don't disagree with the metanalysis, but I don't think you can take those results and conclude anything, one way or another, about the carcinigenicity of nicotine in cigarettes or e-cigs!

She-Hulk's Bottom-Line: Studies, and metanalysis of the safety of shorter nicotine replacement therapy in the form of a nicotine patch (and probably longterm nicotine patch use which hasn't been studied) aren't generalizable to making conclusions about the safety of nicotine in tobacco and e-cig smoke due to the much higher levels of nicotine in lung tissue seen in smoking.

 

[She-Hulk]

Remember, however, that the route of exposure for e-cigs is through inhalation and that once inhaled into the body, will undergo metabolism and become various metabolites that are (likely) less reactive. Additionally, the dosing of the nicotine in vivo compared to an in vitro study will be substantially (magnitudes) lower.

This is why studies of nicotine patches aren't a good model for answering the question regarding nicotine's role in the development of cancer in the lung. Nicotine in a patch makes it to the brain to satisfy craving, but it is broke down, and is probably present in lung tissue at a level that is many hundreds of thousands of times lower than what'd you'd get with smoking. You put on a nicotine patch, the nicotine doesn't go and concentrate in the lungs, it goes everywhere in the body.

Smoking causes lung cancer, so some carcinogenic compound(s) are involved in that process over time in the smoker in a cumulative fashion over many years, nicotine could still play a role, obviously, in both cigarettes and e-cigarettes. There is a lot of reason to be concerned.

I have conducted several studies in lung cancer via the inhalation pathway in China, and "tar" is not the same between brands, smoking device, and region. Remember--the additives in cigarettes between cigarette companies is proprietary and heterogeneous. What you get from one brand to another, plus what you get from country to country, is also different.

Here is why I suspect nicotine:

1. Nicotine appears to be a carcinogen, it's causes mutations in a cell's DNA over time.

2. Nicotine is present after smoking in concentration sufficient enough to exert a physiologic effect, obviously, as smokers get cravings and other physiologic symptoms from nicotine. Also, tobacco plants are cultivated to produce high concentrations of nicotine in their leaves. Even if nicotine has mild to moderate carcinogenic activity, the exposure in the lungs and body must be astronomical, perhaps higher than any other carcinogenic substance in tobacco smoke.

3. Yes, tobacco leaves have 4,000 other chemicals and 19 of these chemicals are known to be carcinogenic, YET what is the concentration of these other carcinogens in cigarette smoke and in the lung tissue? Remember that there are stories all the time about the arsenic in orange juice and low levels of carcinogens in this and that, the question is what is physiologically significant.

 

[She-Hulk]

Re: Michael Siegel, he has strong opinions and he's not a "traditionalist" on the social-behavioral end of research. What he's suggested in his work is that traditional forms of health education (i.e. "educate, inform, make decisions") does not work as effectively as getting into people's heads and getting at what makes them tick. He thinks the tobacco "Truth" campaigns were particularly effective because it wasn't just a simple "inform, change behavior" type of campaign but was trying to get at the cultural aspects of teenage smoking. My guess is here he's thinking that taking away a tool that has been shown to be effective at tobacco cessation is fool hardy. If you put these tools out of reach--people reach for alternatives--ones we'd prefer people don't go for.

I think the issue is that Siegel has a psychological blind spot (tongue in cheek) in that he believes that the CDC, AHA, American Cancer Society (!), all know what he "knows" (without any clinical trials) is that e-cigs are basically safe, and they decided to trick everybody in the world. Look at a Siegel's blog post from today, Stories,:

CDC Campaign of Deception is Working: Lawmakers are Repeating the Lies to Sell Legislation

http://tobaccoanalysis.blogspot.com/2015/04/cdc-campaign-of-deception-is-working.html#disqus_thread

This is somebody going way off the reservation.

For the past ten years he writes more than 200 posts per year to his blog, except one year, averaging maybe 230 posts a year . . . one year almost 400 posts! The commenters are a little loose as well, half hate him, and the other half hate the "establishment"/CDC.

The *reality* is that the CDC, (and people like me), have a skeptical view of e-cigs based on the available evidence. Is it that Siegel doesn't get it that there isn't an absolute truth in this scenario as the evidence simply isn't there, or that he doesn't understand that people have different minds and opinions from his own. Siegel talks about when he was at the CDC's Office of Smoking and Health and how he wouldn't have let this scenario happen, as if the CDC is trying to do something evil, which he is basically saying when he rails about the massive conspiracy theory of lying, deception and manipulation.

Wow.

Sorry, the CDC isn't running some massive deception campaign . . .

 

[She-Hulk]

Both of the articles you mentioned were works that presented at conferences--there's relatively little vetting of results and abstracts prior to presentation and there may be substantial flaws in their design and results.

Well, there's other evidence that nicotine might be involved in the development of lung cancer, specifically that nicotine activates a protein called beta-arrestin-1 which then nicotine induces the metastatic spread of lung cancer cells. There might well be a doublet or triple hit with regards to lung cancer.

http://www.sciencedaily.com/releases/2015/01/150128141419.htm

There is a political reason for why tobacco company feel much more comfortable with the idea that it is all the "tar" in cigarettes causing lung cancer, heart disease, etc, because nicotine is their bread and butter, and with e-Cigs they certainly hope that nicotine will gain a sterling reputation, even if it is a contributing factor to heart disease and lung cancer. Just saying that there is a reason why the companies push the idea that E-Cigs are safe, they know they're a test of nicotine's safety profile, a real world test, one that counts.

We've all heard for years and years that nicotine is the addictive component of cigarettes, and the nebulous "tar" is what causes the cancer, but this was really just an educated guess, and there is a physiologic rationale that nicotine might play a role in the development of lung cancer, if not the sole role.

 

[Stories]

Look, I know you're on a tirade right now. Calm down.

Just wanted to point out that when reference that article that you're blasting, I was answering a question you had about cardiovascular events.

I'll let the last comment as this: IARC has not found it worth its time to address whether or not nicotine is a carcinogen. IARC is probably the leading authority on classifications of compounds and carcinogenicity--they're also relatively conservative.

 

[She-Hulk]

Look, I know you're on a tirade right now. Calm down.

Just wanted to point out that when reference that article that you're blasting, I was answering a question you had about cardiovascular events.

I'll let the last comment as this: IARC has not found it worth its time to address whether or not nicotine is a carcinogen. IARC is probably the leading authority on classifications of compounds and carcinogenicity--they're also relatively conservative.

I'm not the one writing a post a day about the CDC deception campaign! Obviously, you take great umbrage at criticism of a professor from your institution, fine, enough said.

I apologize if you think I'm on a tirade, just interested in this topic.

No, IARC hasn't investigated nicotine as a carcinogen in terms of direct effect on humans, but perhaps that will change as c-cigarettes provide an opportunity to do just that in a more focused fashion, though there are other carcinogens in e-cigs as well. It might be a mischaracterization to say that the IARC hasn't found it "worth it's time" to look at the issue as maybe it is so hard to study the effects of nicotine isolation in cigarettes.

 

[She-Hulk]

Anyway, read an interesting article which said that Dr. Mike Siegel is "likely the most well-known proponent of electronic cigarettes in the public health community".

http://www.ecigadvanced.com/blog/michael-siegel-interview/

Siegel says in the YouTube video below that e-cigarettes aren't a Tobacco Industry ploy to get around regulations, that e-ciagarettes are a "different type of industry" and different type of product. Yet aren't tobacco companies jumping into the e-cigarette market?

He says that cigarettes are essentially unregulated, and it wouldn't make sense to regulate e-cigs more!?! He said that people are "confused" because vaping looks like smoking and people think they're both dangerous . . . but this doesn't explain the vast majority of public health officials who have concerns.

Siegel also gave a speech to the Tobacco Merchants Association!, apparently on e-cigs . . . is he paid by this "new" industry completely (double wink) unrelated to the "tobacco industry" when he gives speeches at the Tobacco Merchants Association?

Interestingly, somebody in the comments mentioned that e-cigarettes help keep smokers of traditional cigarettes addicted by allowing them to consume nicotine in public areas where smoking is prohibited, thus maintaining their addiction.

Siegel will be giving a speech at the Tobacco Merchants' Association Centennial Celebration and Conference at the end of May in Williamsburg Virginia . . . appropriate given that Virginia was the colony that grew all the tobacco way back when.

 

[She-Hulk]

TIME has an article about a growing number of health groups asking for regulations of e-cigarettes (Siegel doesn't want e-cigs to have as much regulation as cigarettes which he says are basically unregulated anyway), here are some snippets:

Earlier this week, 31 health and medical groups including the American Academy of Pediatrics, the American Academy of Family Physicians and the American Heart Association wrote a letter to President Obama asking for the federal government to finalize the “long-overdue” regulation. The medical groups say cigar and e-cigarette brands are using marketing tactics that they feel appeal directly to young people, like promoting candy and fruit-flavored products, and they want regulations to put an end to it.

. . .

Health experts are concerned over a recent U.S. Centers of Disease Control and Prevention (CDC) report that showed e-cigarette use among middle school and high school students tripled between 2013 to 2014 and hookah use doubled. The report showed that e-cigarette use among high schoolers increased from 4.5% in 2013 to 13.4% in 2014, which is a rise from approximately 660,000 students to 2 million.

. . .

“My concern is always the first-time users,” says Shyam Biswal, a professor in the department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health. “It’s bad it took so long to make a dent in [conventional] tobacco users, and we are now starting something else, and we are just waiting and waiting and waiting. We don’t have the data that e-cigarettes are a gateway [to other tobacco products], so we just wait. It should not be like that.”

http://time.com/3843214/e-cigarettes-regulation-health-experts/

 

[She-Hulk]

For better or worse, the CDC is going to start running ads targeting e-cigarettes:

http://www.14news.com/story/28733290/new-cdc-anti-smoking-ads-targeting-e-cigs

At least one ad slams e-cigs for not being an effective smoking cessation tool:

 

[She-Hulk]

Hot from Monday's presses more from Siegel:

Physicians, Health Departments, Politicians, and Anti-Tobacco Groups are All Spouting Misinformation About Electronic Cigarettes

Usually we look to physicians and health departments to provide us with accurate information about health risks. However, in the case of electronic cigarettes, physicians and health departments are disseminating false and misleading information. They are being joined by policy makers. All have fallen for the lies that CDC and the FDA have been spreading as part of their campaigns of deception regarding e-cigarettes.

Can anybody tell me why the CDC and FDA would promulgate a deception? Just wondering if there is any rationale as to why the CDC/FDA/American Cancer Society and others would perpetuate this supposed falsehood? (Outside of the Illuminati wanting to sterilize half the population or something like that).

Siegel also had this little warning for the CDC in a previous article:

I call on the CDC to immediately retract these statements before any further damage is done. Failing to do so will only solidify my conclusion that the agency is intentionally misleading the public to promote its anti-e-cigarette agenda.

Wow . . . anyway, TIME has an article briefly discussing a decision by a government agency which says that there isn't any proof that e-cigarettes are an effective cessation strategy:

http://time.com/3845871/best-way-to-quit-smoking/