Study: Banning E-Cigarette Sales to Minors Spurs Conventional Smoking | Hacker News Reader

Study: Banning E-Cigarette Sales to Minors Spurs Conventional Smoking

medicine.yale.edu

37 pointsmhb63 comments

Can someone explain the backlash on e-cigarettes to me? I feel like I'm in the midst of a tobacco lobby organized press campaign at times.

Here is how my thinking goes: 1) nicotine is essentially another caffeine and not a public health risk, 2) the cancer from smoking is from the literal act of burning things, which emits cancerous material and then by inhalation deposits it in your lungs and finally, 3) e-cigarettes don't emit the same cancerous materials since they only vaporize a nicotine-liquid, and are hence safe.

I feel like I can make the conclusion in 3) with just basic understanding of why cigarettes are bad (and e-cigarettes safe), yet it seems no one in the press is prepared to make the small logical leap. Am I overestimating my knowledge here?

I'm not an expert, but there is some evidence that nicotine alone can lead to heart disease.

Caffeine also has CVD impact, as well as GI and mental health.

The difference between caffeine and the chems in e-cigs is that caffeine consumption typically only involves the user. Where-as e-cig consumption too often involves the user, plus all those stuck in the same room/elevator.

If this were a nicotine patch, it wouldn't be such an issue.

E-cigs do not dose bystanders with nicotine.

They do, plus other chemicals either in the liquid vapor, or created by the heat in the vape.[1][2][3]

[1] http://www.medicaldaily.com/secondhand-smoke-goes-electronic...

[2] http://www.medicalnewstoday.com/articles/281762.php

[3] http://www.webmd.com/smoking-cessation/news/20140903/e-cigar...

None of these links suggest that bystanders are dosed with nicotine by e-cigarettes.

Its unclear and all over the map.

There's a famous study from '97 in direct opposition based on nicotine gums and patches and I quote:

"Clinical trials of NRT in patients with underlying, stable coronary disease suggest that nicotine does not increase cardiovascular risk"

http://www.ncbi.nlm.nih.gov/pubmed/9180099

On the other hand there's something in e-cig fluid aside from nicotine that seems to be a cancer risk

"E-cigarette vapor, both with and without nicotine, is cytotoxic to epithelial cell lines and is a DNA strand break-inducing agent. Further assessment of the potential carcinogenic effects of e-cigarette vapor is urgently needed."

http://www.ncbi.nlm.nih.gov/pubmed/26547127

To some extent its like arguing with people about a paleo diet. Twinkies may or may not be good or bad for you, none the less removing twinkies from your diet totally utterly freaks some people out. Likewise it seems highly likely that not using ecigs will have no negative health effects, but people will freak out if you suggest not vapeing.

In terms of recreational activities, its probably not as bad as numerous activities like being exposed to fumes from drying paint, stripping and refinishing of furniture, etc. On the other hand its likely far more dangerous than watching TV or reading HN articles.

The vapor from ecigs reminds me of the "liquid smoke" used in old model trains to simulate smoke coming from the stack. I'm concerned about the effects of breathing that stuff in all the time. It's not water vapor as far as I'm aware.

Seems to me like it would be similar to what a fog machine produces. Looks like there have been some studies on it https://en.wikipedia.org/wiki/Fog_machine#Adverse_health_eff...

Breathing high concentrations of water vapor is probably worse for your lungs than propylene glycol. Not that it's good for you, but it's fairly well studied.

It's glycerine. AFAIK that's about as safe as water.

Pull a MSDS on glycerine, you will not be happy to discover there are all manner of problems, enough mist will kill you quite effectively, externally it kills rabbits at a level corresponding to swimming in it acutely, long term skin exposure is very unclear. Various governments have differing views on how much is safe to breathe in a workplace along the lines of ten or so milligrams per cubic meter which isn't much. I can't get a straight answer on oral toxicity; drinking somewhere around half a percent body weight kills half the mice, so if I did the math right in my head, if you are a man sized mouse, drinking the equivalent of a wine bottle of pure glycerin in one sitting might lead to very serious medical problems (like death, for example). The long term effects listed sound scary for kidneys and "reproductive organs".

In the short term it appears fairly hard to get killed by glycerin. Long term it doesn't sound very good at all. In that way, it reminds me of benzene or PCBs where in the short term theres zero risk if you can avoid drowning, but the long term effects are pretty awful.

Its definitely not as safe as water. Of course the "real" problem is likely whatever else is in the fluid. Who knows whats in there.

Glycerin, taken orally, has roughly the same LD50 as table salt from the MSDS I'm looking at (glycerin = 4090 mg/kg LD50 orally for mice versus 4000 mg/kg for table salt)[1][2], lest we start a panic.

Second-hand smoke is generally accepted as a bad thing, as is wood smoke, unsurprisingly. I've seen suggestions that wood smoke may be even worse simply on the merit that a great volume of nasty compounds are released, and the particulate material is substantially smaller (due to the higher combustion temperatures) and can enter more deeply into the lungs[3]. If it's a choice between cigarettes and someone sucking down glycerin vapors, I think I'd be much happier to accept the latter.

[1] http://www.sciencelab.com/msds.php?msdsId=9927350

[2] http://www.sciencelab.com/msds.php?msdsId=9927593

[3] http://www.ehhi.org/woodsmoke/health_effects.shtml

Safer, in this case. Vaporized water in the lungs can lead to pneumonia.

Plus I hear it has dihydrogen monoxide in it which can kill you in numerous ways.

Combustion of "safe" molecules can produce unknown chemicals that are potentially hazardous. This is why smoke is bad. Vapes (ecigs) have a pretty wide operating range, especially when modded to operate at different wattages. They claim to only vaporize liquid, but at high operating temperatures they could break down molecules, which is still combustion, just to a lesser degree. When you start adding all assortments of aromatic compounds used in flavoring, saying everything is safe is impossible. They may be food grade flavorings, but they probably weren't all tested under the conditions seen in a vaporizer.

The main argument for vapes is that hey don't produce tar, which is one of the worst parts of cigarettes.

Are they as bad a normal cigs? Probably not. Are they completely, 100% safe? No.

On the one hand, a known and potent human carcinogen.

On the other, an application of the precautionary principle that may well be just as applicable to the acrylamide on french fries.

How does this make sense as a vector for backlash?

The "backlash" is largely propelled by user's disregard for others around them. Users regularly can be witnessed using their e-cig indoors and in close proximity to others. These users often say "it's only water vapor", which is absurdly false.

In my state its illegal to smoke vapes anywhere its illegal to smoke cigarettes. This largely keeps it out of public spaces. I don't know how this applies to other states.

Also there is debate in the community about respect. I have more friends that step out for a vape, just like they would for cig, so they don't bother non smokers, than puff away like its nothing. But that's purely anecdotal.

> The "backlash" is largely propelled by user's disregard for others around them.

I can say the same thing about those having backyard firepits [1] whose output affects FAR more people than a single (e)cigarette. To my knowledge no one is campaigning against big campfire though.

Edit:

> These users often say "it's only water vapor", which is absurdly false.

Yes, but does second-hand e-cigarette smoke cause significant harm? For example second-hand cigarette smoke increases the chance of lung cancer by 20% when living with a smoker [2]. Contrast that with inhaling a puff of e-cigarette second-hand-smoke in a public place once in a while.

I understand that you may find e-cigarette smoke annoying but that's not a sufficient reason to ban something in a free society.

[1] http://www.ehhi.org/woodsmoke/health_effects.shtml

[2] http://www.surgeongeneral.gov/library/reports/secondhandsmok...

That's an argument to ban backyard campfires - not an argument to allow indoor e-cigarette use.

You don't get the right to harm other people's health (even in a "free society"), even if there are already other unhealthy things present.

> You don't get the right to harm other people's health, even if there are already other unhealthy things present.

What about the effects of pollution emitted when you drive a car?

This is the same exact argument you made above.

You are making really good arguments for banning/regulating other harmful things - You are not making good arguments for allowing a known harmful thing to continue unregulated.

I think the argument AlexandrB is making is: Compared to pollutants such as campfires and car exhaust, vaping is a rounding error. However much you care about banning vaping, you should care 1,000x more about limiting campfires or diesel engines. Even a tiny change in those would benefit public health vastly more than a vaping ban.

The difference is that vaping only benefits the vaper, but the harms caused by vaping affect everyone.

In contrast, everyone in society benefits from the mobility and economic activity facilitated by transportation. Even if you never drive a car, take a bus, or even leave your house, you are better off because of cars, busses, trains, and airplanes because of the increased economic growth they facilitate. The benefit and the harm are both fully socialized.

That's a fallacy of relative privation though. "B happens more frequently, is more dangerous, or causes more harm than A. Therefore A can be ignored."

AlexandrB was dismissing one argument because he found a bigger issue.

Any time we walk outside with a cold, use your car, drive on less than 8 hours of sleep, or choose not to get a flu vaccine we put other people's health at risk. We accept a certain level of risk to function as a society. If the acceptable threshold of risk was less than "possible threat to another person of any magnitude" we would be a very different society. It seems to me that we use a different rule to decide when to ban activities which is "good evidence of substantial amount of harm(drinking and driving, or second hand smoke)". I would argue that in order to ban e-cigarettes we need to wait for evidence that e-cigarettes are likely to cause significant harm to bystanders.

> To my knowledge no one is campaigning against big campfire though.

You must not be from the bay area. Lookup "Spare the Air".

Yep. In most of the cities I've lived in in California, backyard fires have been completely banned, and fireplace fires have been restricted.

> I understand that you may find e-cigarette smoke annoying but that's not a sufficient reason to ban something in a free society.

Of course it is! We ban a lot of things that are annoying. We have noise ordinances and various other public nuisance laws, as do all other free societies.

I'm a huge fan of personal freedom (don't care what people smoke), but yeah I have to agree with you here. I did some work for a firm where the system administrator walked around puffing huge clouds of this foul-smelling vapor that was something like a cross between strawberries and old socks, and it was really aggravating.

Did you talk to him about this? It seems to me that if someone is creating unpleasant or distracting sensations (noise, smell, vibration, flashing lights, etc), the best thing to do is ask them to stop. Wanting to ban the annoying thing is a bit of an overreaction.

To use an analogy: Lots of people on public transportation annoy me by playing music out of their phone's speaker. At no point do I think, "Phones should be banned." I just ask them to turn off their music or use headphones.

On one hand, chemophobia is rampant in our society. The infamous dihydrogen monoxide story is a prime example.

On the other hand, acrylamide is a single, testable molecule. Taking a mix of chemicals, heating them up to high temperatures, enough to evaporate them, and hoping that they don't break down into anything dangerous is much harder to test. Arbitrary organic compounds can decompose before water boils, or they can sustain high heats. Its really a case by case basis. And the solution for vapes may be similar, but the flavoring solutes vary.

> Can someone explain the backlash on e-cigarettes to me?

Mostly everybody distrusts the companies involved. I suspect there is also some PR by tobacco since these liquids don't require the tobacco industrial complex.

E-cigarettes do seem to be "better" for you than standard cigarettes.

However, you probably still don't want adolescents using them. We have mounting evidence that habitual use of nicotine, alcohol, marijuana, etc. all have negative effects on a developing brain that they don't have later on an adult.

In addition, I really don't want to be breathing a miasma of stuff somebody exhales.

However, I'm still torn on bans. Cigarette bans seem to kill local music scenes--which I like very much. I don't know if the ban is the cause, though--it could just be that bans only follow an influx of boring, rich people who displace the artists.

You realize that you're breathing stuff somebody exhales every time you're around other people, right?

If most people around you are exhaling clouds of "vapor" at regular intervals, you may need to re-evaluate your surroundings.

I can't tell if you're joking. If joke: well played.

News flash: You're exhaling clouds of vapor with every breath. However, you can't generally see it.

Yes, but normally they aren't exhaling toxic junk.

And, in flu season, I tend to cut back on group gatherings as much as possible because, exactly, they ARE exhaling toxic junk.

> In addition, I really don't want to be breathing a miasma of stuff somebody exhales.

I think that a lot of the heavy-handed anti-smoking measures are based on neo-puritanism about "toxins" and bodily purity and not on actual health facts. Otherwise you would see a lot more people talking about exposure to camp fire smoke [1].

Tobacco companies are absolutely evil and should have been sued out of existence for lying to the public. But after years of advocacy and anti-smoking campaigns nearly everyone is aware of the risks and some are continuing to smoke anyways. Bans will just create a new black market for tobacco products.

[1] http://www.ehhi.org/woodsmoke/health_effects.shtml

> I think that a lot of the heavy-handed anti-smoking measures are based on neo-puritanism about "toxins" and bodily purity and not on actual health facts.

In terms of individual, probably.

However, the smoking bans were "nominally" put in place to protect the people working in places like bars, restaurants, etc.

It was something that "the market" was never going to correct. People who smoke are simply WAY more profitable to restaurants and bars.

Don't forget the cultural effects such as neopuritanism and anti-hipster-ism.

Some of the backlash is of course the smell, from people insisting on using them indoors or generally in close quarters.

What chemicals are in the liquid is mysterious and vaguely unregulated so who knows. Its not as regulated as food and drink or pharmaceuticals. Its not unrealistic to assume its just different cancer causing materials, not no cancer causing materials at all. Its basically at the patent medicine level of regulation.

Main concern is that people fully expect issues to be found down the line. Would I bet $100,000 that we won't discover any currently-unknown harmful side effects from vaping in the next thirty years? I wouldn't. It's similar to how with each iteration of safer food-grade plastic we end up finding something harmful about it.

It's not a good reason to make it illegal, as I think harm should be proven before making something illegal, but I like that people are exercising some skepticism and concern over the unknown unknowns for a new technology, especially one that involves smoking.

The study found an increase of "0.9%", yet doesn't give a margin of error (and the journal article is paywalled[0] for $40), and that sounds like a really small increase, so small that for all we know, the actual (as opposed to measured) delta was zero or negative.

How can this be useful for public policy debates if the full text is not publicly available? And how can we find errors in publicized studies if we can't even read them?

[0]: http://www.sciencedirect.com/science/article/pii/S0167629615...

I think this is the original article, legally, for free: http://scholar.harvard.edu/files/afriedman/files/how_do_elec...

Protip: google the article's name + pdf, and quite often you'll find the original on the author's website.

> restricting supply of a good increases demand for substitute goods

> reporters don't understand consumer theory

> most headlines can be rephrased in a reductive manner

Problems with "E-Cigarettes":

1) They are loaded with chemicals known to cause harmful effects

2) It's not "just water vapor" that is exhaled by users

3) Users insist on using them indoors and in close proximity to others (see #2)

4) The large lobbying effort to make them socially acceptable often straight-up lies about their effects (again, see #2)

Just about the only "Good" thing about them is the lack of carbon being inhaled and released into the air (smoke)... otherwise they are just as bad as plain old cigarettes. What we have done is taken the Tobacco leaf + additives and removed the Tobacco leaf, leaving only the additives.

The lack of scent in the air doesn't mean the harmful "second-hand" chemicals are not present... it just means the tell-tale smell of burning paper and tobacco isn't present, making E-Cigarettes more dangerous to bystanders (no sensory warning signs to detect).

Regarding the lie that is #2, it if really was "just water vapor" being exhaled, you would not have inhaled it in the first place (there would be no effect). The lungs do not 100% process all of the chemicals being inhaled, which means you are exhaling them into the air just the same.

> They are loaded with chemicals known to cause harmful effects

So are roasted coffee beans.

> It's not "just water vapor" that is exhaled by users

It's less toxic than tobacco smoke.

> Users insist on using them indoors and in close proximity to others

So did cigarette smokers. This tendency is not written in stone.

> The large lobbying effort to make them socially acceptable often straight-up lies about their effects

Citation needed. Is this a bigger or smaller problem than how Big Tobacco has historically operated?

> Just about the only "Good" thing about them is the lack of carbon being inhaled and released into the air (smoke)... otherwise they are just as bad as plain old cigarettes.

You're completely ignoring the largest benefit -- there is no combustion occurring. Combustion results in many more (carcinogenic) toxins being created. Inhaling nicotine vapor is inherently much safer than inhaling tobacco smoke.

> Inhaling nicotine vapor is inherently much safer than inhaling tobacco smoke

We need to stop kidding ourselves - inhaling any chemical is not "safe", or good.

E-Cigarettes are on the road to being banned indoors, and possibly other places as well. It's the same user behavior (and complete disregard for others around) that led to traditional cigarettes being banned indoors etc.

> We need to stop kidding ourselves - inhaling any chemical is not "safe", or good.

Ehh.. I don't know. Everything in nature is about trade-offs. Generally speaking, maybe the nicotine buzz is worth the side-effects of vaping.

You're an idiot.

> You're an idiot.

Citation needed. ;)

In seriousness, this isn't reddit, guy.

Make an argument, or comment something insightful.

> E-Cigarettes are on the road to being banned indoors

1) That's pretty much unenforceable. If you take a hit and hold it in for 10 seconds, then no vapor is exhaled. I use mine in movie theaters, and no one is the wiser.

> The lungs do not 100% process all of the chemicals being inhaled

2) See #1.

> inhaling any chemical is not "safe", or good.

Oxygen seems a pretty safe chemical to inhale. Pretty good too.

Oxygen at 21% yes. At 22%, it's like alcohol: it burns tissues and at some point it's ignitable on contact with any fat. The opposite is the risk of neutrogen, even though it's stable and neutral, is to decrease oxygen concentration.

> Oxygen seems a pretty safe chemical to inhale. Pretty good too.

Concentrated Oxygen can and will kill you, or cause severely negative effects[1]

It just goes to show how something seemingly mundane can have potentially devastating results when misunderstood.

[1] https://www.quora.com/Why-does-breathing-pure-oxygen-kill-yo...

You're aware that water, oxygen, and vitamin C are all chemicals.

All chemicals pose different risks in different amounts. And this is what we are trying to determine with e-cigarettes. Does second hand e-smoking cause significant harm to by-standers?

> It's less toxic than tobacco smoke.

Sure, but if it is still toxic, I shouldn't have to breathe the secondhand smoke. Smokers can do what they want to their own lungs, but I don't want to be on an airplane or a bus breathing in that stuff.

In the same breath you decried smokers for affecting your health and admitted to doing two things that contribute to air pollution that affects everyone's health.

Are you suggesting that arguments for banning secondhand smoke in public places are equally valid arguments for banning flying and driving?

> They are loaded with chemicals known to cause harmful effects

Proper e-cig liquid consists of the same stuff that is used in fogger/hazer machines for decades, though here in medical purity grades, nicotine if wanted, and a bit of aroma.

Hardly comparable to the stuff that's in cigarettes, that includes also radioactive materials like polonium.

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