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Here's Why IMA's White Paper on e-Cigarettes Seems Misleading & Possibly Flawed (Part I)

Here's Why IMA's White Paper on e-Cigarettes Seems Misleading & Possibly Flawed (Part I)
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Disclaimer: The purpose of this article is not to encourage the consumption of nicotine in any form or to counter IMA’s medical report, it is merely to dissipate information. I have zero medical knowledge and its best to do your own share of research before reaching a conclusion that fits your lifestyle choice. I am also not preaching which makes an obvious safer choice, that is for the readers to conclude themselves, but merely explaining what Indian media has lost in their attempts to provide click-bait headlines. Views expressed are strictly personal. In spirit of a full disclosure, I also want to mention that I wish I was, but sadly I am not sponsored by any vaping/ big tobacco company for this article. 

On 10th May 2016, the Indian Medical Association or IMA, which is a voluntary organization for representative, national voluntary organization of Doctors of Modern Scientific System of Medicine in India, released a controversial white paper on electronic cigarettes. Their official website states their mission, among others is: “To promote and advance medical and allied sciences in all their different branches and to promote the improvement of public health and medical education in India”. While one may debate over the efficiency of their work in progress, and as the famous show on Indian TV titled Sataymev Jayate exposed the massive corruption scandals going on there, they undoubtedly play the largest role in deciding the public thought, action and suggestive legal advocacy of medical sciences.

The 38-pointer bill in question has raised several eyebrows in the Indian vaping community and concerned vapers worldwide. Some have pointed out glaring mistakes in the report, others have cited several reasons why the report should be taken with a pinch of salt. Some points from a Reddit thread (from a vaper's point of view) on the topic:

  • All medical reports must be peer reviewed. Medical science, as with other concepts in science can only be taken with confidence when they are peer reviewed, and not controlled by only one organization. The report does not point toward any evidence of it being peer reviewed.
  • No citations, sources, images, reports or medical studies, their funding and sources of funding, tests are mentioned in the paper.
  • Logical deductions do not conclude science, especially medical science. Only tried and tested studies do. The paper has no links to any such study.
  • The paper is contradicting itself in several points, where some point that studies and not complete but so far point that e-cigarettes are much safer than traditional cigarettes, but the very next point contradicts the same statement
  • There are glaring omissions and emphasis is not laid on the killer tar produced by traditional cigarettes as compared to e-cigarettes
  • The studies utilize ancient technology for e-cigarettes and not the newer devices which are much safer and controlled. Sure, older devices are still available in the market, but in order to test the general effects of vapes, it is logical to either use the safest (or most popular) device on the markets yet, or at least mention that older devices are referred to
  • The report contradicts a majority of worldwide reports by independent laboratory, doctors and medical associations of several countries including UK

Allow me to break down the report, avaible at (http://www.ima-india.org/ima/left-side-bar.php?scid=441) pointer by pointer.

 “1. Is a type of electronic nicotine delivery system 2.  It’s a battery-operated device that heat the liquid to produce a vapor that the user inhales. 3. E-cigarettes were invented in 2003 in China. 4. Compared with nonusers and conventional cigarette smokers, e-cigarette users are younger, more educated, and have higher incomes”

The emphasis on the words “more educated” should be equal, if not more, on the word younger. By logical deduction, a more educated consumer will try to minimize harm, and insist/ research on finding the complete truth about vaping before adopting the habit. That is good for the community and possibly a better target audience for vapers. Regarding younger audiences, which local media have exaggerated to make misleading headlines, refer to the very next point in the report,

“5. Most adult and adolescent regular users of e-cigarettes already smoke conventional cigarettes”

Here, we see a contradiction of sorts. How can the users of e-ciggarettes be younger than traditional cigarette consumers, if they are already smoking conventional cigarettes? That sounds like an oxymoron! Vaping is neither advertised or promoted by any company, or follower vapers as a habit to pick on – it is targeted as specifically for smokers looking to make a safer choice.

"6. First-generation e-cigarettes mimic the shape and size of conventional cigarettes and may be referred to as "cigalikes."  Second-generation e-cigarettes are larger than conventional cigarettes and are either pen-style (medium size) or tank-style (large size). Third-generation e-cigarettes are known as "personalized vapors."

Here, it is crucial to note, as I mentioned earlier, we would utilize only third generation devices for studies. Failure to do so would result in flawed results, for example studying the effects of pollution by using a 1980’s motorcycle with its muffler taken off and using leaded petrol would be deliberately misleading because nop vehicles currently use that technology at all (except maybe a handful).

"8. Across all brands, the main components of the liquid vaporized are nicotine, propylene glycol or glycerol, and flavorings."

This pointer is important to note because there’s a contradictory statement that opposes this very line later on.

"9.  Nicotine content of e-cigarettes and liquids vary and usually range from none (nicotine-free) up to 36 mg/mL. Common nicotine concentrations of e-cigarette liquids are 6 mg/mL, 12 mg/mL, 18 mg/mL, or 24 mg/mL."

This statement is correct. However, 99.9% vapers would agree with the statement it is physically impossible to consume anything higher than 12mg/mL on third generation devices. This is because of the sheer volume of the vape and the efficiency at which they work, the nicotine fix is massively huge as compared to first generation devices. Not only would 18 or 24 mg/mL nicotine be nearly impossible to vape in third generation devices because the physical signs of chest heaviness, dizziness and other obvious signs of a nicotine overdose be physically visible, it simply does not make for a pleasant taste or vaping experience. Most users witch to 3mg/mL within a month or two of using higher liquids. For reference, remember on an average cigarettes in India contain around 10 mg/mL of nicotine.

Of course this number is highly debatable because it varies from brand to brand, the style of smoking, and actual piece per piece of a cigarette stick. Let’s assume a person consumes a pack a day, or twenty sticks. That’s 200 mg of nicotine being ingested. To consume the same amount of nicotine a vaper would have to vape around 30 mL of e-liquid in his/her vape, which is a challenging task (if they’re using 6mg/mL liquid, which like I stated earlier, is not common,; most users are happy with 3mg/mL after a month or two of consumption.

"10.  Propylene glycol or glycerol are the main components of most e-cigarette liquids; some products may use ethylene glycol. Unlike conventional cigarettes, e-cigarettes can be sold with flavorings. More than 7000 flavors are available, including candy, fruit, soda, and alcohol flavors. Flavorings may increase the attractiveness of e-cigarettes to youths, especially those who are not already smokers"

The oldest trick in the book to ban something is “what will happen to our children?”. I’m going to skip the moral debate here over other influences on children that are more accessible despite being illegal, such as fruity flavored alcohol, prescription medications designed in cute animal shapes, or illegal narcotics that are specifically targeting the youth. Merely adding flavors does not give rise of a reason to appeal to youth. Adults have every right to consume any fruity flavor of cigarette they want, and infinite additional flavors are available to top-up traditional cigarettes. Hookahs, for example, come in all possible edible flavors and have been under scrutiny for the very same reason. But, let’s look at the practical, on ground reality of these statistics. A third generation device is not going to cost any lesser than at least thirty five hundred rupees and must be shipped from outside India as Indian head shops only stock first generation devices which are incredibly stale, outdated and not appealing to anyone (including youth). If your children can manage to sneak this lump of money, pay using a credit card, wait days for its delivery, figure out how to configure it on their own (because modern devices are incredible difficult to configure for a first time user) then perhaps it is the guardian/parents fault for not keeping a check on their children. Would a child wait 4-5 days, order online, learn how to use it, pay at least 3500 rupees simply to vape or just go one of the millions of shops that sell traditional cigarettes without ID checks despite the law mandating so and simply smoke a traditional cigarette?

"11.  Some e-cigarettes contain enough alcohol (used to vaporize nicotine) to affect motor skills, without the user knowing it [December 24 in Drug and Alcohol Dependence.]"

Not only does this contradict the point they themselves mention in point ten, it is simply incorrect. Modern day e-liquids are composed of high medical edible grade Vegetable Glycerin; the same component used in cakes, nicotine, and certified flavors. You can also pay extra to buy Kosher grade vegetable glycerin. In fact, without the nicotine added, you can drink a homemade e-liquid if you know it only has a vegetable glycerin and flavors and nothing else as much as you like and the only side effect would be to get fat (it’s super high in calories) and possibly running to the washroom (glycerin is a mild laxative). If you don’t trust your e-liquid vendor, you can also make your own at home, which is not only legal to do currently in India, but also a fun process. Alcohol has no relevance in modern e-liquids. This is simply a factually incorrect statement and can be verified from any vendor of e-liquid or a medical testing facility anywhere.

(Read the rest of the article continued by clicking here)

Edition: December 2016

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