(Part II) Here's Why IMA's White Paper on e-Cigarettes Seems Misleading & Possibly Flawed Disassembling IMA's white paper on e-cigarettes, with positives and negatives labeled clearly

Disclaimer: The purpose of this article is not to encourage the consumption of nicotine in any forms, and not 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 wish I was, but sadly I am not sponsored by any vaping/ big tobacco company for this article. 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.

Read part I of the article by clicking here

12. Metals such as tin, lead, nickel, and chromium have been found in e-cigarette liquids and vapor. Other compounds detected include tobacco-specific nitrosamines, carbonyl compounds, metals, volatile organic compounds, and phenolic compounds 20. Other carcinogenic compounds have been found in e-cigarettes but in trace amounts that are much lower than levels found in conventional cigarettes. These include tobacco-specific nitrosamines, carbonyl compounds, metals, volatile organic compounds, and phenolic compounds

To counter argue this point, it's easy to look at the pointer number 10 and refer to any basic knowledge of chemistry. You simply cannot generate metals out of thin air. There must be some by-product that produces these metals as alleged. Neither does vegetable glycerin nor the flavors used have any form of metals in them, which can be verified with the supplier, or best, made at home yourself. It is argued that the metals may have crept through heating of the coil element. That is possible, but largely unlikely and here's why. Most educated vapers utilize stainless steel wires or kanthal, which is manufactured to last much, much hotter temperatures that most users vape. So unless one deliberately wants to kill oneself, it would be very difficult to produce metallic vapor from coils. Other compounds detected related to tobacco specific may be true, and that could be alarming news to vapers.

13. Nicotine exposure from e-cigarette use, as with cigarette smoking, increases heart rate and produces measurable levels of blood cotinine, a nicotine metabolite 14. Experienced e-cigarette users tend to take longer puffs and use the device more intensively compared with novice users. As a consequence, they have higher blood nicotine levels that more closely resemble the levels achieved by smoking conventional cigarettes . In less-experienced users, however, the nicotine delivered by e-cigarettes is consistently lower than nicotine delivered by conventional cigarettes

This is neither new nor debated. It is very well acknowledged and understood, and unfortunately for vapers that still chose to pursue this habit, the aim is harm reduction and not harm elimination. However, using sensibly, it is logically possible to consume lesser nicotine than say, from a pack a day's smoker. This is completely dependent on the user's consumption.

15. E-cigarettes do not expose the user to many of the constituents of cigarette smoke (eg, tars, oxidant gases, and carbon monoxide) that are responsible for many of the tobacco-attributable diseases

Let's read this statement over and over again, and make this statement into headlines. There. IMA themselves said it. Vapes save you from many of tobacco-attributable diseases.

16. Most believe that inhaling e-cigarette vapor is likely to be less harmful than inhaling cigarette smoke but the consequences of chronic inhalation of e-cigarette vapor are unknown, and levels of toxic and carcinogenic compounds may vary by e-cigarette liquid components and device used

Exactly! There's scope for improvement and research. Like I mentioned earlier, if oone makes their own e-liquid or uses a brand third generation device where you frequently check temperature control and change the coils and wicks preventing even a slight burn, you're reducing harm. At least that's what we know till now.

17. Little is known about the overall safety or the carcinogenic effects of propylene glycol or glycerol when heated and aerosolized. At high temperatures, propylene glycol decomposes and may form propylene oxide, a probable human carcinogen 18. Glycerol produces the toxin, acrolein, though the levels produced are lower than conventional cigarettes 19. Both propylene glycol and glycerol decompose to form the carcinogens formaldehyde and acetaldehyde, with levels depending on the voltage of the battery used in the e-cigarette

Sure, acrolein, can be produced, but the temperatures we are talking about are not reached under normal usage. 180 degrees for Propylene Glycerol and around 220 degrees C for vegetable glycerin, but using modern temperature control third generation devices and stainless steel wires; you can tweak your device to run at the exact degrees you want. Simple, safer, and scientific.

21. Similar to cigarette smoke, e-cigarette vapor contains particles 22. It is not known whether the particles in e-cigarette vapor have any toxicity. 23. The limited, available evidence suggests there may be potential for e-cigarettes as a smoking cessation and/or harm reduction tool but more trials are needed to evaluate the safety and use of e-cigarettes in smoking cessation 24. Studies have suggested that e-cigarettes may decrease cigarette cravings and reduce symptoms of nicotine withdrawal. However, the efficacy and safety of e-cigarettes as smoking cessation tools and how they compare with the available US Food and Drug Administration (FDA) approved pharmacotherapies are unknown

Self explanatory.

25. Given the concerns that e-cigarette use may be a gateway to nicotine dependence in adolescents, many public health authorities have recommended restricting e-cigarette marketing and advertising to youth, much in the same way that conventional cigarette smoking advertising is restricted. 31. E-cigarettes with higher nicotine concentrations are regulated as medical devices. The directive includes regulation for the maximum amount of nicotine in e-cigarette liquids and requires child tamper-proof packaging. 32. As per WHO, regulations are needed to stop promotion of e-cigarettes to nonsmokers and young people, minimize potential health risks to users and nonusers, stop unproven health claims about e-cigarettes, and protect existing tobacco control efforts

Definitely, there should be no argument that vapes should be regulated to be sold only to adults and without advertisements to prevent it's attraction to adolescents.

27. There are concerns about the potential health consequences of secondhand exposure to e-cigarette vapor. 28. Passive exposure to e-cigarette vapor produces small increases in serum cotinine, comparable with that from passive exposure to cigarettes. However, passive exposure to e-cigarette vapor is expected to be less toxic to bystanders than combustible cigarette smoke 36. Though it does not produce smoke but it is producing vapors which may be harmful to the person sitting in vicinity. Therefore, all it should under the jurisdiction of anti smoking rules of India i.e. COTPA.

This is arguably frightening and needs to be looked after to reduce second hand vaping. Worldwide, however, several studies have argued that second hand vaping may not be that harmful at all, even in a closed environment.

28. Passive exposure to e-cigarette vapor produces small increases in serum cotinine, comparable with that from passive exposure to cigarettes. However, passive exposure to e-cigarette vapor is expected to be less toxic to bystanders than combustible cigarette smoke 29. e-cigarettes have been banned in some countries (including Brazil, Singapore, Canada, and Uruguay) 30. In Europe, the European Parliament approved a directive that regulates nicotine-containing e-cigarettes with concentrations up to 20mg/mL as tobacco products 33. US FDA does not regulate e-cigarettes. 34. Use of e-cigarettes should not be permitted in hospitals or healthcare facilities. Conventional cigarettes are not allowed in these venues. 35. Nicotine replacement products, not e-cigarettes, should be used to manage nicotine withdrawal symptoms in hospitalized smokers.

Does not apply / irrelevant / agreed

38. Since it is taken as aerosol therefore it should be placed in the category of Hukha. Hukha also provides vapors

This is the most flawed science there has ever been written! A Hookah does NOT produce vapor or an Aerosol! It produces smoke that is a lot cooler and flavored so the user has a feeling of not burning his throat too much. It is well established that a Hookahs contains monumentally larger doses of cancerous tar and on an average session the user will consume much higher amounts of nicotine than from conventional cigarettes. Hookahs cannot, by any science and logic, be compared to a vape because Hookahs burn the tobacco and contain tar whereas an e-liquid undoubtedly does not.

So where do we stand?

Positives:

• Carcinogenic compounds have been found in e-cigarettes but in trace amounts that are much lower than levels found in conventional cigarettes.
• E-cigarettes do not expose the user to many of the constituents of cigarette smoke (eg, tars, oxidant gases, and carbon monoxide) that are responsible for many of the tobacco-attributable diseases
• Passive exposure to e-cigarette vapor is expected to be less toxic to bystanders than combustible cigarette smoke
• There may be potential for e-cigarettes as a smoking cessation and/or harm reduction tool
• Studies have suggested that e-cigarettes may decrease cigarette cravings and reduce symptoms of nicotine withdrawal

Negatives:

• May be harmful, not as much as cigarettes, but still to bystanders
• Carcinogenic compounds have been found in e-cigarettes but in trace amounts that are much lower than levels found in conventional cigarettes
• Higher temperature usage or using cheaper wires may produce toxic metals
• Not researched enough so entire effects aren't really completely known

Every vaper would suggest that vapes are not completely healthy, because nothing can ever be as safe as pure, natural air itself to be pumped in your lungs. The reason why vapers across the world and in India are switching is for harm reduction. Use your own logic, research, and see what suits your own body better. Of course, without a doubt, quitting nicotine in all its forms is the best option, but if that is not possible for you to do, then there are other options to help you across that journey. Medically speaking, patches and gums may be safer than vapes.

(with inputs and feedback from The Great Indian Vaping Community)

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