June 10, 2014
This public comment has been submitted to the FDA.
The “Continuum of Risk” Must Include Cardiovascular Disease
Comment Submitted in Response to FDA Regarding Proposed Rule Deeming Tobacco Products to be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Regulations on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products
Docket No. FDA-2014-N-0189
Suzaynn F. Schick, PhD, Ganna Kostygina, PhD and Carolyn Calfee, MD
University of California, San Francisco
June 9, 2014
Most of the discussion of “continuum of risk” that the FDA states that it intends to use in its rulemaking (p 23144) has been focused on cancer. While e-cigarettes deliver lower levels of carcinogens than conventional cigarettes, the ultrafine particles and nicotine that these products deliver have important effects on the development of cardiovascular disease and triggering of cardiac events that are likely to be as large as for inhalation of combusted tobacco products.
June 10, 2014
Sara Marini and colleagues just published an interesting paper, "Short-term effects of electronic and tobacco cigarettes on exhaled nitric oxide," in Toxicology and Applied Pharmacology that shows that, among smokers, inhaling e-cigarette aerosol has the same effect on the production of exhaled nitric oxide as inhaling a cigarette whether the e-cigarette has nicotine or not.
They also provide another confirmation that e-cigarettes produce more and smaller particles than conventional cigaretttes.
Nitric oxide (NO) is important because it makes smooth mucle relax and the fact that exposure to e-cigarette aerosol reduces exhaled NO in the lungs may help explain why people who use e-cigarettes have a drop in lung function. (The fact that smoke reduces NO production in arteries is an important reason that smoking and passive smoking contribute to heart attacks.)
The results in this paper are also evidence that the fact that e-cigarettes and cigarettes generate the aerosol differently doesn't matter in terms of this biological effect.
Here is the abstract of the paper:
June 10, 2014
We just submitted this comment to the FDA. (The figures are in the PDF of the comment that is tied to this link.)
FDA Should Restrict E-cigarette Marketing to Protect Youth as Part of the Currently Proposed Regulation
Docket No. FDA-2014-N-0189
LM Dutra, ScD1; RA Grana, PhD1; L Lempert, JD1; JK Cataldo, RN, PhD1; SA Glantz, PhD1; BL Halpern-Felsher, PhD2; PM Ling, MD1; L Popova, PhD1; M Walsh, EdD1
1 Center for Tobacco Control Research and Education
University of California San Francisco
2 Department of Pediatrics, Stanford University
June 10, 2014
June 9, 2014
Clive Bates, a private consultant and well-established e-cigarette advocate, has organized a remarkable letter to WHO Director General on 26 May 2014 signed by 53 public health specialists criticising WHO for not enthusiastically embracing e-cigarettes as a harm reduction technique.[1]
The most notable thing about the letter, which contains several sweeping scientific statements, is that it does not contain a single reference to the scientific literature, particularly the substantial literature that does not support the political position the letter advocates.
Here are a few broad reactions before getting in to the specifics:
June 8, 2014
Randy Uang, Richard Barnes, and I have just completed your state report on Illinois, Tobacco Policymaking in Illinois, 1965-2014: Gaining Ground in a Short Time, which can be downloaded for free here.
Here is the Executive Summary:
Health and Budgetary Costs of Tobacco Use in Illinois
- Tobacco-induced diseases cost $785 million in state Medicaid expenditures in 2005; over1 percent of the state budget in the 2010s went to treating the health effects of tobacco.
Tobacco Industry Influence