M.O.V.E. – Medical Organizations supporting Vaping & Electronic cigarettes

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CALL FOR DOCTORS, HEALTH CARE PROFESSIONALS AND SCIENTISTS IN SUPPORT OF ELECTRONIC CIGARETTES.
 
As physicians and health professionals we see everyday patients who are severely affected by tobacco smoking, many of whom will eventually die or have their health severely affected despite our help and advice. Tobacco smoking remains the most serious public health issue in the world.
People smoke for the nicotine but die from the chemicals produced when tobacco is burned.i Unfortunately, currently available smoking cessation medications have limited efficacy and acceptability for the majority of smokers. However, we believe that there is a solution: the use of electronic cigarettes clearly has huge potential to help many smokers turn their backs on tobacco.
To this end, we strongly believe that ethically and scientifically speaking it is our responsibility to draw attention to the following:
  • It is the combustion of tobacco and the 4000 chemical substances that are produced when smoking cigarettes that are harmful to health of smokers, not the nicotine.
  • The dangers of electronic cigarettes are considerably lower than those of tobacco. From analysis of the constituents of e-cigarette vapour, e-cigarettes can be expected to be at least 95 to 99% safer than smoking tobacco cigarettes in terms of long-term health risks.ii
  • The vapour exhaled from e-cigarette users is highly unlikely to be harmful to bystanders; nicotine concentrations in exhaled vapour are too low to have pharmacological effects on bystanders.iii
  • Randomised controlled trials show that e-cigarettes are effective in smoking cessationiv and studies of the use of e-cigarettes in real world settings show that they are more effective than other means for stopping smoking including Nicotine Replacement Therapy.v
  • It is estimated that for every one million people who switch from smoking to electronic cigarettes, some 6000 premature deaths a year would be averted.vi
E-cigarettes do not ‘renormalise smoking’ – ‘vaping’ is not smoking.  In many countries the rise in e-cigarette use has been accompanied by a continued decline in tobacco sales and prevalence of smoking.vii
The characteristics of electronic cigarettes should always be compared to those of conventional cigarettes, and discussion about the absolute long-term safety of electronic cigarettes must be contrasted ethically and scientifically with the absolute certainty of the harmfulness of smoked tobacco.
Already estimated 29m consumers in Europe use e-cigarettes.viii But we believe that the individual and public health gains associated with electronic cigarette use are held back by misconceptions about the product.
In light of the numerous studies undertaken to date we – as health professionals – cannot remain passive in the face of the clear public health benefits of electronic cigarettes.
We therefore recommend that our colleagues actively learn more about electronic cigarettes as a new public health tool in the ongoing global health campaign against tobacco-related diseases.
We call on our colleagues to sign this declaration in support of the merits of electronic cigarettes based on scientific evidence and ethical debate.
Yours faithfully,
Group of professionals who support this statement.
If  you  agree  with  the  M.O.V.E  statement  please  click  on  the  image  below  to  add  your  support.

i Russell, M. A. Low-tar medium-nicotine cigarettes: a new approach to safer smoking (1976) BMJ  1 (6023) 1430-1433

ii Farsalinos, K. E., & Polosa, R. (2014). Safety evaluation and risk assessment of electronic cigarettes as tobacco cigarette substitutes: a systematic review. Therapeutic Advances in Drug Safety, 5(2), 67–86. doi:10.1177/2042098614524430

iii Hajek P, Etter J-F, Benowitz N, McRobbie H (2014) Electronic cigarettes: review of use, content, safety, effects on smokers, and potential for harm and benefit. Addiction.

iv McRobbie, H., Bullen, C., Hartmann-Boyce, J., & Hajek, P. (2014). Electronic cigarettes for smoking cessation and reduction. The Cochrane Database of Systematic Reviews, 12, CD010216. doi:10.1002/14651858.CD010216.pub2

v Brown, J. et al (2014).  Real-world effectiveness of e-cigarettes when used to aid smoking cessation: a cross-sectional population study. Addiction doi:10.1111/add.12623

vi West, R. B. J. (2014). Electronic cigarettes : fact and fiction. British Journal of General Practice, (September), 442–443.doi:10.3399/bjgp14X681253

vii West R, Brown J, Beard E. Trends in electronic cigarette use in England. Smoking Toolkit Study 140122. 2014.www.smokinginengland.info/latest-statistics

viii Vardavas, C.et al (2014). Determinants and prevalence of e-cigarette use throughout the  European Union: a secondary analysis of 26 566 youth and adults from 27 Countries.  Tobacco Control, 1–7. doi:10.1136/tobaccocontrol-2013-051394

As seen here:

https://sciencecig.wordpress.com/move/

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The FDA and Electronic Cigarettes, a Timeline… by Steve k.

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ImageThe Food and Drug Administration and electronic cigarettes have a pretty long and storied history.  I’ve commented about the FDA and its attempts to ban and demonize ecigs pretty extensively.  I’ve realized perhaps not everyone is intimate with the rocky road we’ve been down. I thought perhaps a little perspective on how things have progressed so far might shed some light and provide a little context for many of the things discussed in the community.

To that end, I’ve put together a little timeline of how things have progressed with the FDA up to this point.

2007

Electronic cigarettes begin to make their way to the United States after experiencing some popularity in Europe.

2008

August 2008 GreenCig, a Chinese manufacturer registers their product with the FDA.  According to this post on the ECF, the company classified their device as a nasal inhaler. There was a great deal of debate on the forum as what that meant, and even what types of nicotine was FDA Approved.

September 2008 The World Health Organization issues a press release for e-cigarette companies to stop making health claims about e-cigarettes being an effective smoking cessation therapy.  The WHO states that “WHO has no scientific evidence to confirm the product’s safety and efficacy.”  The release also notes that some marketers claimed the devices had the approval of the organization.

November 2008 GreenCig’s application for approval of its electronic cigarette is rejected by the FDA. The FDA cited the application as a new drug submitted without study data.

2009

Early 2009 FDA begins seizing electronic cigarette shipments as they enter the country via China.  The agency cites the Food Drug and Cosmetics Act as grounds for seizing the devices as incorrectly labeled medication and delivery devices.

March 2009 A group of Senators headed by Senator Lautenberg of New Jersey urge the FDA to crack down on electronic cigarettes (despite the fact that the FDA was already seizing shipments by this point). Several bloggers pointed out that the senator received significant funding from the pharmaceutical industry.

April 2009 e-Cigarette Company Smoking Everywhere files a lawsuit in federal court to stop the FDA seizure of electronic cigarettes. The company’s primary argument is that electronic cigarettes are a cigarette product and not medical devices.

April 2009 The FDA releases its lab report on electronic cigarettes.  This report will be the basis for the future FDA press release attacking electronic cigarettes.

May 2009 nJoy joins Smoking Everywhere’s suit against the FDA.  nJoy made no health claims in its marketing material, which appeared to be the FDA’s basis for seizing shipments.

June 2009 President Obama signs the Family Smoking Prevention and Tobacco Control Act into law. The law gives the FDA jurisdiction over tobacco products. See the FDA’s Infographic for more detail on what the act entails.

July 2009 The FDA releases their infamous press release making a number of negative claims about electronic cigarettes based on limited testing of cartridges from Smoking Everywhere and nJoy (the two companies suing the agency). The claims included:

  • e-Cigarettes were marketed directly to young people
  • diethylene glycol (used in antifreeze) found in one cartridge
  • Samples contained carcinogens
  • Samples contained toxic chemicals
  • The original press release didn’t mention varying nicotine levels, that appears to have come later

July 2009 NJoy publishes an analysis of the FDA’s lab report (edit: original link is dead, here is a copy of a cached version) citing a number of deficiencies in the report. Among the findings:

  • Lack of standard protocols
  • No comparison to nitrosamines in nicotine replacement products
  • Many substances mentioned were below normally detectable quantities
  • Many impurities were present but less than found in the Nicotrol inhaler
  • Nicotine levels in the control device (inhaler) were not published
  • No study of the vapor was conducted.

August 2009 Tobacco Control advocacy group Action on Smoking and Health (ASH) files an Amicus brief in the Smoking Everywhere lawsuit in support of the FDA.

September 2009 An ad-hoc group of e-cigarette proponents, the Alliance of Electronic Smokers filed an Amicus brief in favor of the e-cigarette companies and disputing the ASH brief.

2010

January 2010 The FDA is ordered to stop blocking imports of electronic cigarettes by Federal District Judge Richard Leon. Judge Leon noted that the FDA could use its newly granted tobacco regulation powers to deal with electronic cigarettes according to an article in the New York Times.

February 2010 The FDA wins a temporary stay of the injunction issued in January pending a review by the appeals board. The FDA is free to continue blocking shipments.

April 2010 A group of of public health organizations including he American Academy of Pediatrics, the American Cancer Society Cancer Action Network, the American Heart Association, the American Legacy Foundation, the American Lung Association, the American Medical Association, the Campaign for Tobacco-Free Kids, and Public Citizen file an Amicus brief in support of the FDA’s actions.

June 2010 Smoking Everywhere drops out of the court case. At the time, there were questions surrounding the company’s ability to survive amidst the legal fees and impact to its business caused by the seizures.

June 2010 nJoy files a brief appealing the stay on the basis of adverse impact on its ability to conduct business in addition to the FDA’s inability to demonstrate harm from electronic cigarettes.

July 2010 Another Amicus brief is filed in support of the FDA by health advocacy groups.

September 2010 The FDA sends a warning letter to five e-cigarette companies: E-CigaretteDirect (not the UK vendor), Ruyan, Gamucci, E-Cig Technology and Johnson Creek.  The letter states that the agency intended to regulate the products under the Federal Food, Drug and Cosmetic Act and their products were not in compliance.

September 2010 The Federal Appeals Court hears arguments concerning the stay of the injunction in the nJoy V FDA case.

September 2010 (Side Note) The New York Times publishes a piece that the FDA caved to political pressure from Senator Lautenberg and others to approve a knee replacement device that the agency had previously denied approval.  Clearly not e-cigarette related, but I thought I would just leave that here.

December 2010 The Federal Appeals court rules in favor of nJoy and reinstates the injunction against electronic cigarette seizures. Judge Leon advises the agency to use the Tobacco Control act to regulate e-cigarettes. The FDA must decide if it wishes to take its case to the Supreme Court.

2011

Janurary – March 2011 Various vendors report in online forums and blogs that the FDA is continuing to stop electronic cigarette shipments into the country in defiance of the court order from December, 2010.

February 2011 Totally Wicked sues the FDA over shipment seizures in the wake of the previous court ruling.

April 2011 The FDA announces it will not appeal the decision in the nJoy case. The FDA finally stops intercepting e-cigarette shipments. The agency announces it will pursue e-cigarette regulation under the Tobacco Control Act. In its letter, the FDA announces that intends to leverage the following steps to regulate the devices under the Act:

  • The Agency intends to propose a regulation that would extend the Agency’s “tobacco product” authorities in Chapter IX of the FD&C Act, which currently only apply to certain specifically enumerated “tobacco products,” to other categories of tobacco products that meet the statutory definition of “tobacco product” in Section 201(rr) of the Act.   The additional tobacco product categories would be subject to general controls, such as registration, product listing, ingredient listing, good manufacturing practice requirements, user fees for certain products, and the adulteration and misbranding provisions, as well as to the premarket review requirements for “new tobacco products” and “modified risk tobacco products.”
  • The Sottera decision states that products made or derived from tobacco  can be regulated under the Tobacco Control Act unless they are “marketed for therapeutic purposes,” in which case they are regulated as drugs and/or devices.  The Agency is considering whether to issue a guidance and/or a regulation on “therapeutic” claims.
  • Section 201(rr)(4) of the Tobacco Control Act prohibits the marketing of “tobacco products” in combination with other FDA-regulated products. As mentioned, FDA has already issued a draft guidance on this provision, which it intends to finalize.
  • “Tobacco products” marketed as of February 15, 2007, which have not been modified since then are considered “grandfathered” and are not subject to premarket review as “new tobacco products.”  A “tobacco product” that is not “grandfathered” is considered a “new” tobacco product, and it is adulterated and misbranded under the FD&C Act, and therefore, subject to enforcement action, unless it has received premarket authorization or been found substantially equivalent.   FDA has already developed draft guidance explaining how manufacturers can request a determination from FDA that a “tobacco product” is “grandfathered.”

May 2011 Totally Wicked voluntarily drops its suit against the FDA in light of the announcement and the FDA’s stopping seizures.

July 2011 The FDA announces its intent to have draft regulations concerning other tobacco products (including e-cigarettes) by October.

October 2011 A group of Senators led again by Senator Lautenberg send a letter to the FDA urging the agency to “move swiftly” to begin regulation of electronic cigarettes.

December 2011 The FDA announces a comment period for regulation of non-face-to-face sales of electronic cigarettes, leading to speculation that the FDA may severely limit online and mailorder sales of electronic cigarettes.

2012

May 2012 After several quiet months from the FDA, lets slip via a sources sought request that it intended to have draft regulations of e-cigarettes in place by Summer 2012. The request was for technology to identify online and offline advertising for tobacco products.

August 2012 The FDA releases a report on “adverse events” reported from e-cigarette use. The report showed some 100 adverse effects were reported.  Analysis of the report on the ECF noted that there are millions of users of the system, and a number of individuals thinking they were being helpful submitted adverse impact reports for things like “being able to breathe easier” which likely artificially inflated the number of adverse impacts, which likely are just a handful of things.

Today

Summer has passed, and no draft regulations have been put forth by the FDA. Speculation among the cigar industry is that the agency likely won’t propose anything until the election is over. There is further speculation that the exact steps the FDA takes will depend on the political landscape after November.  This is perhaps true, but it seems to me that the train has already left the station and the FDA will roll something out in the future.

How oppressive it will be, nobody knows.  Speculation ranges from simple quality control over e-liquid on the low-end to very strict regulation allowing only pre-filled cartridges with either tobacco or menthol flavoring (along with online sales and advertising bans) on the extreme end of the spectrum.

Thank you for sticking with me through this massive undertaking.  I hope I gave you a little more perspective on how the FDA exists within our vaping culture. I’d love to hear what you think about the FDA and any potential regulations in the comments!

September 26, 2012 – Steve K. – http://stevevape.com/

E-Liquid: Which liquid nicotine strength is right for you?

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When it comes to deciding on your e-cigarette liquid, you want to get it right. Every decision in this process is an important one, yet choosing the right e-liquids nicotine strength is right at the top among the most important. It can make all the difference between success and failure in using your e-cigarette as an alternative to traditional tobacco.

Before you happened upon this ingenious little device called the electronic cigarette, you probably had no idea there was such a thing as liquid nicotine. We all equate nicotine with tobacco cigarettes, or maybe nicotine gum or the patch at most. You know now that e cigarette liquid forms a key component in what makes an e-cig so effective for so many people, but it can also scare consumers because of the negative association that nicotine has picked up over the years.

You’ll be surprised to know that nicotine on its own, and in moderation, really isn’t bad for you. In fact, there are studies that point to the positive effects of nicotine usage. Studies have shown that nicotine can help you focus, increase your cognitive process, and even help treat symptoms of depression and Alzheimer’s disease.

Choosing the right nicotine strength has a lot to do with how much you smoke and which type of cigarettes you smoke. Let’s take a look at the basic parameters in accordance with the most popular e cigarette liquid standards on the market right now:

choosing nicotine strength, eliquid, chart, guide

No Nicotine: This level will work for you if you just want the feel of smoking a cigarette. If you are anything more than an extremely light (a few cigarettes a week) smoker, this won’t be enough. At least not in the beginning, but we’ll get to that later.

6mg or 0.6%: Considered the ultra-light level, 6mg can be effective if you are used to smoking ultra-light cigarettes such as Capris or Pall Mall ultra-lights.

12mg or 1.2%: Here we start to get into the area where more smokers fall into. This would be considered a light level nicotine strength for most e-cigarette brands. If you smoke a light cigarette, especially if you smoke less than a pack a day, this could fit your needs well.

18mg or 1.8%: The majority of smokers will want to start with this level of liquid nicotine or higher. If you smoke a full flavored or regular cigarette and have up to a pack a day, you will want your e cigarette liquid to contain at least 18mg of liquid nicotine.

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5 LEADING BENEFITS ELECTRONIC SMOKING HAS OVER TRADITIONAL CIGARETTES

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In order for someone to switch brands or consider alternatives, they need to clearly see the benefits of the new approach. E-cigarettes are no different.

Many, if not the vast majority of those interested in electronic smoking, are current smokers. Chances are you’re one of them – searching for an alternative but wanting to understand the benefits of switching from your current brand.

E-cigarettes are indeed an alternative to traditional cigarettes. They’re a suitable alternative for many because of the benefits they have over “smoking.”

We invite you to continue reading for 5 of the leading benefits electronic smoking has over traditional cigarettes…these benefits were discovered from customer feedback as well as numerous scientific studies examining both traditional and e-cigarettes.

Reason #1 – E-cigarettes do NOT have that distinctive odor

Just about anyone knows – cigarettes smell!! It’s their hallmark.

Scent from cigarette smoke gets into, and clings, to just about anything it comes in contact with – hair, clothes, your car – anything. Not only does the odor cling, many consider cigarette smell offensive and avoid close contact. If you’re a smoker, you don’t notice it so much since you’re immersed in it all of the time. To non-smokers, and especially ex-smokers, this smell is very noticeable.

One reason cigarette smoke smells so bad is because you’re burning tar and chemicals in addition to the tobacco itself. Properties from burning these substances make them cling to clothing, hair, walls, furniture, etc.

E-cigarettes on the other hand do not have this ominous odor because instead of exhaling smoke, you’re exhaling a vapor that evaporates almost immediately. Customers and non-smokers/vapers report the smell from an e-cigarette to be either nonexistent or reminiscent of cotton candy or even pop tarts!!

Whatever it is, e-cigarettes certainly smell a whole lot better than traditional cigarettes.

Reason #2 – Electronic smoking is MUCH cheaper than traditional cigarettes

If you’re a smoker reading this, you can certainly relate to this point – cigarettes are expensive these days.

In 1980, you could buy a good quality pack of cigarettes for $1. By the 90s, the cost had risen to $2, on average. Today, a good quality pack of cigarettes will cost you anywhere from $7 to $12 depending on which state you’re in.

Some of this increase in cost can be attributed to regular inflation or rising prices of production (tobacco) and even distribution (fuel).

Taxes however play a big role too. In 2009 for example, the federal tax was raised from $0.39 to $1.01 per pack. Add state taxes, which vary, and taxes end being around 20% of the cost of a pack of traditional cigarettes.

Between all of this, a pack-a-day smoker can spend upwards of $300 each month! And this doesn’t include the cost of other incidentals such as lighters, ash trays and much more.

E-cigarettes do not share this dilemma. While some of the entry costs of a starter kit may be a little bit higher, the month-to-month cost of electronic smoking is typically about half when compared to traditional cigarettes. Cartomizers and batteries constitute the bulk of this expense, which can range anywhere between $20 and $40 depending on how much you vape.

Currently, e-cigarettes are not subject to any sort of taxes like traditional smokes are. Also, as the technology develops and becomes more mainstream, the cost will continue to decline (…think cell phones, DVD players, etc.).

Reason #3 – E-cigarettes are much safer

Since you’re “burning” tobacco, not to mention using an open flame to light it, traditional cigarettes by default pose serious fire hazards. Cigarettes are in fact the #1 cause of fire-related death in the United States and 7 other countries. Worldwide, fires started by lit cigarettes constitute 10% of all fire-related deaths.

With e-cigarettes, you’re not burning an open flame and don’t have a hot cherry that can burn you, your clothes, your furniture, and so on.

There was an incident where an e-cigarette exploded in the user’s face in early 2012. It was determined though that the particular unit the person was using was a “mod,” which is a way vapers can alter their devices for more power that involves stacking the batteries. When used as intended, there have been no reports of an e-cigarette exploding.

Reason #4 – Health

While we can’t make the claim that e-cigarettes are healthier, we can point out how traditional cigarettes are harmful to your health.

You don’t have to take our word for it – there are countless studies out there showing how smoking traditional cigarettes can put you at a higher risk of a whole host of conditions, including (but not limited to) – stroke, heart attack, lung cancer, throat cancer, pneumonia, osteoporosis, Alzheimer’s, and countless others.

Traditional cigarettes contain a litany of chemicals as well, many of which are considered carcinogenic, or cancer causing.

Many of our customers have reported feeling better physically after switching to electronic smoking.

Reason #5 – Social

Last but not least are the social impacts of traditional cigarettes, which is in a way related to reasons one through four. Over the years, smoking has increasingly been viewed negatively by society at-large for a variety of reasons.

The smell, the health consequences, and even the healthcare costs all combine to give traditional cigarettes a bad name these days. If you’re a smoker, you’ve certainly noticed an increasing amount of restrictions around where you can light up, even at private parties where the host is a nonsmoker.

Also, traditional cigarettes can have impacts on your social life, literally. Take dating for an example – it’s pretty rare for a nonsmoker to be with a smoker. Also, smoking can also impact job prospects since more employers are taking a more critical eye toward traditional cigarettes.

As you can see, e-cigarettes and electronic smoking carry many benefits over traditional smoking. Many have discovered how they can still enjoy smoking and get the nicotine they crave without using methods that are increasingly seen as intrusive and irresponsible.

E-cigarettes from Eversmoke provide this alternative in a cost-effective, easy way. If you’re searching for that alternative, consider trying Paradise Vape. http://www.paradisevapeusa.com