Friday, December 12, 2014

Are E-cigarettes safe? Notes from the FDA December Workshop

I love technology. I was able to attend a two day conference held by the FDA in Washington DC without leaving home. The entire event was available live-stream. The only downside was it started at 8am east coast time and I live on the west coast, so I was getting up early.

This conference was a public workshop about E-cigarettes. Presenters included researchers from around the country, including a few delivered by representatives from the tobacco companies. There was a lot of science discussed and while I'm not a scientist, I could follow most of the discussion.

I'm not going to go into all the details and information that was presented but here are the highlights that I gleamed from this workshop:

  • Everything presented at this workshop is already out dated. E-cigarette technology is expanding so fast that it is almost impossible to keep up with the advancements. 

  • The evolution of e-cigarettes may hold great promise to curb the tide of death and disease from traditional smoking. However, because of the lack of product standardization, manufacturing  and product standards, there is the potential for a great deal of harm.

  • Studies regarding impurities, contaminants and toxicants vary greatly in outcomes because there are over 450 manufacturers of e-cigarettes and many different variations in product type. Levels of most toxicants are significantly lower that those in traditional cigarettes but the range is very wide depending on the manufacturer. There is a concern that high amounts of harmful chemicals are created with higher voltage batteries.

  • Every study is limited to what product is used. For the e-liquid there are over 7000 flavors with approximately 200 new flavors being introduced each month. 

  • Manufacturing standards are needed. Products in the marketplace currently vary greatly in chemical composition and quality of product. Counterfeit and sub-par products are widely available. Some manufacturers have established some good manufacturing and product standards.
  • Some of the concerns are: leaching of metals from the atomizer/cartomizer because of poor quality materials. Some chemicals in the flavors which are considered to be safe for ingestion, are hazardous when inhaled. GRAS (generally recognized as safe) is a designation issued for food products only and any claim that flavors are FDA approved as GRAS is false and misleading. The FDA does not issue approval for food flavors but letters of "no objections". Poor quality batteries can over heat and/or explode. E-liquids made by unscrupulous manufacturers substitute preservatives which are poisonous. Some flavors are toxic. 
As far as how e-cigarettes will be regulated in the future is anyones guess but it is clear that to protect the public that manufacturing and product standards need to be established. Products need proper labeling as to exact contents. E-liquids need to be in child resistance containers, with a limited amount of nicotine available (less than a lethal dose) and a flow restrictor in the lid. Had these last regulations been in place, the death of a young child in New York a few days ago, may have been avoided. 

Monday, September 8, 2014

I'm only a social smoker, what's the big deal?

Melanie considered herself a social smoker. Her husband smoked and she would bum a couple of his cigarettes when she was drinking, usually at a party or out to dinner, She considered herself healthy because she ate a low-fat diet and exercised daily; yet she had a high risk for heart disease. She had a family history of heart disease, her father had died from a heart attack in his fifties. She was 65 and had high cholesterol. She complained that her throat hurt after a night of smoking, which turned out that it wasn't one or two cigarettes but often five or six over just a few hours.

Her doctor explained that there is no safe level of smoking. Anyone with any risks for heart disease should not smoke or even be around secondhand smoke because of the damage smoke does to the cardiovascular system.

There are 7,000 chemical in smoke. Many of these chemicals damage both the function of your heart and your blood vessels. Any amount of smoking even light smoking causes damage.

One of the main components is carbon monoxide, the same gas that comes out of the tailpipe of your car. Once in your blood stream, it binds to red blood cells faster than oxygen and the body is oxygen deprived for a few minutes which can lead to either a heart attack or stroke.

Smoking just one cigarette will:
·        Increase your blood pressure
·        Increase your heart rate
·        Constrict your bronchial tubes which makes your lungs work harder
·        Doubles the amount of carbon monoxide in your system and prevents oxygen from reaching your vital organs
·        Decreased the temperature of your hands and feet by constricting small blood vessels

Social smokers believe that smoking enhances their pleasure in social situations. Some social activities such as parties, golfing, playing cards become a trigger to smoke. For some individuals what starts as just a social activity can become an addiction due to the highly addictive nature of nicotine. Smokers don't start out smoking a pack a day but will start out only smoking now and then. Nicotine changes the structure of the brain reinforcing the desire for a cigarette. It can take as few as 100 cigarettes for the brain to become addicted to nicotine and now the social smoker is a full time smoker.

To quit successfully a social smoker needs to realize they can have fun without smoking. They may need to avoid social situations where they have always smoked until smoking is no longer a temptation. Abstaining from alcohol will make it easier.

There is a reason why firefighters wear masks when approaching any fire; our bodies are not made to inhale smoke and there is no safe level of smoke. So my advice to any social smoker is to stop now before any more damage is done to your body and to prevent becoming addicted.

Friday, September 5, 2014

I am a former smoker, what should I do went I am with my friends who still smoke?

​Just something to think about when you are with friends who still smoke----None of us want to be that nasty holy-than-thou former smoker who shames their smoking friends but do you 
1. want to be around secondhand smoke? 
2. Enable your friend in their addiction?
1. Secondhand smoke is a carcinogen. Instead of saying to a friend--"you can't smoke around me." Say- "I (have a medical problem, for me it was cancer) and my doctor has told me not avoid 2nd smoke as much as possible, it is best for my health. I'm not telling you to not smoke, only that I can't be around it. When she lights up--excuse yourself and wait until she is through and then come back. You don't need to say anything else.  You don't need to say what the medical problem is--it could be one of the many risk factors for heart disease or cancer. you might have diabetes, or be pregnant.
2. Enabling addiction--if your friend was shooting heroin would you stay around them and enable them to continue to use heroin? Heroin is less likely to kill your friend than smoking. Most smokers if they are really honest - do want to quit. In the Stages of Change--the first step is not-wanting to quit, one of the psychological interventions is-- social liberation---making their behavior a problem for THEM. People say you can lead a horse to water but you can't make them drink. I feel it is my duty to make that horse AWARE of his thirst and then remove all obstacles between him and the water. In other words, smokers won't quit until smoking is a problem for THEM. Every little thing that makes it more inconvenience for them to smoke, is another little irritation that changes their thinking from "I don't want to quit, to - maybe I should think about quitting."
Three examples: 1. A girlfriend of mine wanted her husband to quit smoking. He could only smoke outside and so they spent a lot of time on the patio so he could smoke. My recommendation to her was to stop sitting out there when he smoked. She didn't need to say anything but by staying out there while he smoke, was condoning his behavior--he had no reason to change--he could smoke AND enjoy her company. If she stopped going out there he was not getting the reinforcement (of her company) that he wanted. He started smoking less and finally did quit.
2. A girlfriend of mine, who smoked, came to visit (she lived in another state). I told her that she couldn't smoke inside my house but could go outside. First time she went out, she left the glass door open and was still talking to me as she lit up. I came over and closed the door and remained inside. I said I didn't want the smoke smell coming into my house. Years later she told me that the action of closing the door on her--caused her to smoke less cigarettes and less of each cigarette. She also thought about her behavior. I don't know if she ever quit since we lost contact over the years. 
3. I used to run a singles club (Sizzling Singles--another story but a whole lot of fun). We would meet in bars when you could still smoke in bars. Often smokers would come up to me with a lit cigarette to ask me a question. I would immediately stop them and say--"Just a minute I'll be right back." I would either go to the bathroom, to the bar to get some water or some other excuse. Once their cigarette was out, I would go back to them and say either, "I'm a former smoker and I find I am so tempted to bum a smoke that I just can't be around a lit cigarette" or "I'm a cancer survivor and my doctor has told me to avoid 2nd hand smoke as much as possible", sometimes I used both answers. No one was ever offended but sympathized with me and often said they wished they could quit too. 
In each case, no one told the smoker to not smoke, no one was "shamed" about their smoking but boundary lines were set by either blaming your doctor or yourself that you can't be around smoke, making it your problem, not shaming them that they have a problem. But in a subtle way the smoker is given a problem--"I can't smoke and be around my friend". You have just started making that horse be aware that maybe they are thirsty.