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Comment by iaw | Hacker News Reader

> UConn researchers found that e-cigarettes loaded with a nicotine-based liquid are potentially as harmful as unfiltered cigarettes when it comes to causing DNA damage

I don't like the way they've titled their research. Given that there are numerous chemical additives in traditional chemical cigarettes that are known to cause health issues nicotine may not be the dominantly harmful component in cigarettes.

Discouraging cigarette smokers from moving to e-cigarettes is akin to abstinence only programs, it's not a pragmatic approach to the realities of the problem and human behavior. Of course the tobacco industry also has a vested interest in cigarettes so it's favorable to them for media to be as negative as possible about eCigarettes.

If eCigarette second hand smoke is less harmful than cigarettes and they aren't banned in the places that regular cigarettes are it would create a strong downward pressure on traditional cigarette smoking...

..and it looks like the Altria group does recruit from UConn, if that actually means anything.

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Discouraging smokers from moving to e-cigs is a bad idea, but discouraging non-smokers is a great idea. It's a tough tradeoff, and I don't think the analogy to sex ed is really a good one. Virtually everyone has sex, so teaching abstinence is foolish. But most people don't smoke, so saying "don't smoke, not even e-cigs" is a good thing for that segment of the population.

Ideally, you'd get all the addicts to move to e-cigs, and everybody else to not use either one. Not that I have any brilliant ideas how to accomplish that.

> discouraging non-smokers is a great idea Thank you, I hadn't thought about that before and you're completely right.

If the risk profile for cigarettes is just barely too high for a non-smoker then e-cigarettes may be the last 'push' Although this does require some assumptions about why individuals start smoking cigarettes in the first place.

It's sort of like the classic market segmentation problem. Ideally you want to charge each customer the maximum price they're willing to pay, but it's hard to give different prices to different people. Likewise, you want to push each person towards the least harmful version of smoking or non-smoking they'll accept, but you can't tailor general advice like that.

In any case, it seems like much of the e-cig debate comes down to this. Those in favor see it as an alternative to cigarettes for smokers. Those against see it as a way to get non-smokers to consume tobacco.

Or even: get non-smokers to consume over-priced perfumes that have a good profit margin whether or not they contain tobacco/nicotine.

Just this weekend, I saw a friend of mine vape who'd never touched a cigarette. His arguments were "Relax, it ain't a cigarette." and "I only vape for the taste of the liquid."

I expressed skepticism that burning random chemicals and inhaling the resulting smoke is healthy. Good to have some evidence to back that up.

> discouraging non-smokers is a great idea.

Why? If it doesn't have health costs, there's not much reason you should care. This study isn't even on the same planet as measuring health costs.

Yes, if e-cigs are harmless then I don't care. I don't think that's very likely. Nicotine is not good for you. It doesn't look like there's any question as to whether or not e-cigs cause harm, only a question of how much harm.

> It doesn't look like there's any question as to whether or not e-cigs cause harm, only a question of how much harm

Same goes for almost everything.

"Nicotine is not good for you" is slightly misleading - smoking tobacco is really bad for you, and the reasons for that have nothing to do with nicotine; smoking nicotine free tobacco would be pretty much as bad health-wise.

To the first order of approximation, nicotine addiction is bad for your health because it causes you to burn and inhale plant matter, the common delivery methods of nicotine are horribly unhealthy but if you're talking about nicotine as such (for example, through a transdermal patch) then it doesn't really have significant adverse health effects.

What about chewing tobacco? All smokeless tobacco has risks of cancer. I would not say that nicotine is harmless without a large amount of proof, and it should take about as much proof to say that it is not a carcinogen.

There's actually been a lot of research on nicotine, and the conclusion is that it's _slightly_ carcinogenic.

But more to the point, there was little reason to believe it would cause cancer in the first place, compared to any other random compound. Its association with tobacco is a wash, because other compounds, like aldehydes, are completely sufficient to explain the carcinogenicity of smoking tobacco.

The US surgeon general has a really nice, fucking long, document about tobacco.

Everything in it is evidenced by as much research as they can get.

https://www.surgeongeneral.gov/library/reports/50-years-of-p...

I agree that it's a bad idea to take nicotine in any form unless you need to, but it seems that nicotine is one of the less harmful parts of tobacco.

For chewing tobacco it's probably not the nicotine that's causing cancer, but all the other stuff.

Nicotine is a neurotoxin. I'm sure it's fine though, as long as you didn't need your neurons anyway.

Weird how it makes you perform better on mental tasks though

Aren't there a lot of drugs which enhance performance in the short term but are harmful in the long term?

That would be a paradox resolution. I suggest to likewise think of the short term effect as harm, so the long term effect is the accumulated harm.

Just like a light hit on the head would increase awareness, but increasing the force and repetition of the hits on the head is not well advised, when the effect wears off after overuse - to say nothing about the immediate effect of getting hit.

The perceived short term benefits are only secondary effects. And with regards to nicotine, all the arguments in favor are to be treated as extraordinary claims.

I wonder how the testing methodology works.

Tobacco is full of really carcinogenic stuff other than nicotine.

For analysis of nicotine as such, you can refer to the known side-effects of nicotine dermal patches; they're well researched, approved by FDA, etc - the place of application can get skin irritation and itchiness; overdose of nicotine can get dizziness, headache, rapid heartbeat, and nausea (same as for too much nicotine through other means), but they're not known to cause cancer or other significant damage despite being used by very many people over very long time.

I haven't heard much to support nicotine being significantly worse than caffeine.

>Nicotine is not good for you.

Nicotine also has benefits - most notably, it is a stimulant. The question is what tradeoffs you are making by consuming nicotine.

https://www.gwern.net/Nicotine

Inhaling stuff is bad for you. Nicotine itself is not terribly different than other stimulants, e.g. caffeine.

For completeness, one of the issues with e-cigs is that it heats a hydrocarbon by passing it over a poorly-regulated heating element. That's a recipe for creating random organic molecules, many of which are most definitely harmful. Probably not as harmful as old-school smoking, but definitely a case of "do not use around others and do not use except as a substitute for smoking."

can you explain how that's different from toasting bread or roasting vegetables to someone who has a weak understanding of chemistry and what makes molecules harmful?

As someone with a smell allergy, my first approximation to a guess (I am not a chemist), please correct me if I'm mistaken, is something to do with the alcohols contained in most e-cig recipes and borrowed from the perfume industry. Alcohols when aerosolized tend to travel farther than most other smell carriers (that's why perfumes use alcohol) and more directly enter the bloodstream, skipping the body's filters (which makes it particularly useful to e-cigs as a carrier).

I'd suppose other chemicals in traditional cigarettes fill very similar roles.

Well, humans have evolved to eat cooked nutrition. We did not evolve to inhale that cooking smoke.

E-cigs involve direct contact with the heating element at a much higher temperature than food would normally be exposed to. A quick google shows that the element can be as hot as 500F, and the fluid will be in direct contact. Also, the organics used in e-cig fluid are smaller and more easily ripped apart by heat.

Imagine you want your house to smell like coffee. So you heat a baking tray until it is white hot. Then drip coffee onto the tray (don't actually try this). Much of the coffee will be vaporized with the water in it providing a nice aroma. But some of it will be in direct contact with the tray and will burn and have a nasty smell. The hotter the tray is, the more the coffee gets burned and transformed into not-coffee. E-cigs are like that, except one doesn't notice the nasty aroma of the accidental chemicals.

To be fair, while I don't support it, abstinence only sex ed is usually in the context of high school, where it's probably not true that "virtually everyone has sex."

The abstinence part is (almost?) always in the context of "until marriage" which can extend well beyond high school and remains highly mismatched with people's behavior.

It should also be noted that abstinence only sex ed usually involves many outright lies, such as that sex outside of marriage is objectively immoral, that waiting until marriage prevents STIs, vastly exaggerated figures for the risk of disease and failure rates of birth control, etc. Whereas smoking is actually dangerous, and "don't smoke, it'll greatly increase your chances of getting these various horrible diseases" is actually truthful.

The "until marriage" part is usually part of the moral beliefs of the people who push for abstinence only sex ed in public schools, but I wasn't aware that public schools generally taught that part.

I can't speak for others, but I was never taught the "until marriage" clause, and I graduated high school in 2011. We were taught that abstinence was the only way to completely remove the risk of pregnancy or STD/STI, which really doesn't change once you're married or whatever.

Are they teaching abstinence "until you're out of high school"? Otherwise it's either "until marriage" or "until death." I think most kids understand that marriage usually involves sex, even with bad sex ed.

I think they're just teaching "until ..."—as in, they don't have an "until", it's just "don't have sex." As if sex was exactly equivalent to a drug, where if you avoid the particular subculture that "does" the drug, you'll just never need to think about it.

Though I think the true implication is "don't have sex until an impulse comes along to do so, that is strong enough to completely drown out the voice of your superego in your head. And then—if the impulse really is that strong—the 'proper' order to do things is to get married to that person, and then have sex with them."

They do in the South.

And in the Midwest.

Is that totally truthful though? How much do you have to smoke for it to really be dangerous? If I keep a pack around for 1-2 months, and have a few cigarettes a week, how much am I really increasing my chances? I don't smoke 1-2 packs a day like some smokers do, I certainly don't have the same odds do I? Can it be possible that the truth is that you can smoke in moderation without any significant increase in risk? I would certainly like to know the real picture.

All I ever see is picture of black lungs, messages of certain cancer and death. To me, this is like those people who have pictures of dead fetuses for their anti-abortion message. It's extreme, and sets of red-flags in my brain.

I fucking love smoking. It gives me a way to chill out and unwind for 10-15 minutes. It's great for my mental health, because I won't do it in my house... I have to get away from the computer, I have to stop what I'm doing. It gets me away from everything.

Searching around, it looks like even light smoking is still bad. Not as bad, but still bad.

"Light and intermittent smoking carry nearly the same risk for cardiovascular disease as daily smoking.... In addition, the risk of ischemic heart disease in light-smoking men and women aged 35 to 39 years who smoke 1 to 4 cigarettes per day is nearly 3 times that of a nonsmoker."

http://circ.ahajournals.org/content/121/13/1518

There's nothing wrong with taking a calculated risk, but it is a risk.

Just for reference. 1-4 per day would be about a pack every 8 days, averaged. I'd be curious how that compares to a non-daily smoker who as the grandparent suggests, only smokes about once every other day on average.

I expect it's still a significant health risk, but I've never seen studies on people who don't smoke daily.

Those rare smokers practically don't exist; either they are wise and just stop because they were just testing, or they increase their habit, because they are still testing, until they forget why they even started and need the narcotics to numb the pain they caused themselves.

How the damage happens is not important, but consider the possibility of slowly accumulating effects because of a slow rehabilitation potential.

> I fucking love smoking. It gives me a way to chill out and unwind for 10-15 minutes.

Me too. I haven't had a cigarette in over a decade, but I remain hopeful that modern science will find a cure for cancer and other smoking-related diseases during my lifetime, so I can resume smoking again. This probably sounds nuts to non-smokers and I won't bother explaining it any further.

As an aside, I am one of many who tried e-cigarettes when they came out because they were very convenient, and ended up quitting. They were new and not banned anywhere yet, so I could 'smoke' even more. I never liked smoking indoors and do not like the stale tobacco smell so they were great. For reasons I don't really understand my tobacco habit gradually tapered off and I no longer smoke anything, but I do miss it.

For reasons I don't really understand my tobacco habit gradually tapered off and I no longer smoke anything, but I do miss it.

I think I have heard this from a couple of e-cigarette using colleagues: once the switched to e-cigarettes stopping became easier.

(One of them explained that he used weaker and weaker refills until it was basically just water. I guess at that point it just feels stupid.)

Sort of a nitpick but its mixed with vegetable glycerin or propylene glycol (or a mix of thw two), and not much if any water.

Thanks. I actually appreciate that you take the time to correct when I'm wrong.

>All I ever see is picture of black lungs, messages of certain cancer and death.

First of all, I envy you. You're a "chipper" and make up about 5% of the population of smokers. I on the other hand am in the Majority. It's either zero or a pack a day. The black lung photos didn't contribute to my cessation. Instead I had to grow up and decide I didn't like feeling like garbage. That said, If the black lung applies to that 95% of us that can't stop at just one, it's probably the right message.

5% source: http://articles.latimes.com/1996-09-18/news/ls-44883_1_heavy...

"Abstinence only" is terrible at any level. It's a good idea to encourage abstinence, but withholding education about birth control and STD protection is dangerous along the same lines as withholding vaccines.

Getting back to the original topic, we need to know more information about the other additives in e-cigs as well. There are kids at my child's high-school that smoke non-nicotine e-cigs supposedly because they like the taste (they come in fruity flavors).

US government for some time pushed abstinence only AIDS prevention programmes in Africa, against all the evidence of ABC.

Anecdotally, my younger friends seem to be much more ok with someone vaping than smoking cigarettes, to the point that mentioning it is harmful is brushed off. This is among people that are not habitual tobacco users; it seems the advertising must be working...

Isn't it because people naturally assume e-cig smokers are actually ordinary smokers trying to quit? Most e-cig smokers I know fall in this category so I view all vaping people through that lens.

And in that cotext such dismissive reaction makes sense to me.

In the UK e-cig sellers have signed up to a voluntary code of practice where they don't sell product (e-cig devices or juice) to people who haven't ever smoked.

That agreement isn't working very well, lots of sellers will sell to people who say "I've never smoked".

It's a shame, because that's the kind of thing that could force more regulation.

http://www.bbc.co.uk/news/uk-39523857

> The Royal Society for Public Health (RSPH) said 87% of shops were knowingly or unwittingly prepared to sell e-cigarettes to people who have never smoked or vaped.

So assuming you have never smoked and want to vape, go buy a pack of cigarettes first. Smoke one outside the vape shop. Job done.

The whole idea seems kind of pointless. If someone want to vape, let them.

There's some concern that people who vape move to cigarettes.

I think there's been a little bit of research showing some young people moving to smoking from vaping.

> I don't like the way they've titled their research.

The authors' title, as it appears in the journal the study was submitted to is "Automated 3-D Printed Arrays to Evaluate Genotoxic Chemistry: E-Cigarettes and Water Samples" (see http://pubs.acs.org/doi/abs/10.1021/acssensors.7b00118).

The "E-cigarettes ‘Potentially as Harmful as Tobacco Cigarettes’" title comes from "UConn Today", a university news site.

Just to be clear that the academics didn't choose this silly title.

> Given that there are numerous chemical additives in traditional chemical cigarettes that are known to cause health issues nicotine may not be the dominantly harmful component in cigarettes.

Based on your above comment, it sounds like you think that they tested for nicotine specifically. They did not. From the press release:

There are potentially hundreds of chemicals in e-cigarettes that could be contributing to DNA damage, Kadimisetty says. Rather than test for all of them, the UConn team targeted three known carcinogenic chemicals found in tobacco cigarettes. They then loaded their device’s microwells with specific enzymes that would convert those chemicals into metabolites. If these chemicals were in the sample, the test gave them a reading for genotoxicity. If the chemicals were not present, there would be no reaction.

Based on that paragraph, and other sentences throughout the press release, my interpretation is that their findings are that e-cigarettes are potentially as harmful as cigarettes. Some of the comments in this thread make it sounds like the researchers showed that just the nicotine in e-cigarettes is as potentially harmful as just the nicotine in cigarettes, but that's not my reading.

The 'potentially' is a HUGE asterisk here, though.

E-cigarette liquid, at it's base, has two chemicals: propylene glycol and nicotine.

Anything other than that is a flavor additive, or a smoke volume additive (glycerine). PG and Glycerine are extensively studied and safe for human consumption, PG is actually used in nebulizer treatments for people with asthma.

Furthermore, a proper e-cigarette doesn't cause a chemical change in the liquid- it's only a physical state change. That precludes the oxidation reactions that characterize tobacco smoking.

So my skepticism is really tweaked by this article. Yes, someone could potentially add hundreds of flavoring chemicals. Definitely room for a problem there, so address that. The essential cigarette is only two to three chemicals.

The makeup of e-cigarette vapor is different than the what's in the liquid. When vaping, the e-cigarette coil heats up to 300°C and breaks compounds in the liquid (such as propylene glycol) into new compounds such as propylene oxide, acetaldehyde, and formaldehyde. Researchers found that aerosols generated by e-cigarettes contain up to 31 compounds, some of which are known carcinogens.

http://pubs.acs.org/doi/abs/10.1021/acs.est.6b01741

Wow, didn't know that. So, when the article says that "There are potentially hundreds of chemicals in e-cigarettes..." they are actually referring to compounds that are being generated after vaping?

I believe so, but he could also be referring to how there are hundreds of different flavors (each containing different compounds), and each compound interacts differently when heated by coils.

My understanding is that this is a bit of a false alarm, because most devices target 150C, which is just enough to vaporize the PG, but not oxidize it, not 300C where things get ugly. So, with reasonable safety measures in place, this shouldn't be an issue.

The study I citied measured compounds produced by on-the-market e-cigarettes, specifically the EGO CE4 and Kanger Aerotank Mini.

While I'm not sure what temperature these devices target, what I know is that the researchers found that longer into a usage session the coils became hotter and produced larger quantities carcinogens.

My understanding though is that while e-cigarettes do produce carcinogens, they produce less quantities than regular cigarettes do.

Reading a lot of these studies, I get the feel that the researchers aren't really users of the devices, nor have they really consulted any real users of the devices. It's akin to someone who had never seen how a car works being surprised that they are capable of going over 100 MPH. Sure, they can, but usually people don't drive them around that fast. The same goes for e-cigarettes. Sure, if you max out the voltage, keep the coil red hot and dry out the wick you're going to get some bad stuff, but no real user would inhale much of this (at least not more than once) because it would taste terrible.

> most

I guess you had the link to the survey ready and just forgot to paste it. Would you find that again, please?

I also think it's significant that the liquid is vaporized. Certainly it's quite different to smoke tobacco than to eat it.

Vaporization is a physical state change, whereas combustion (and digestion) is a chemical change.

As tristanj pointed out elsewhere in the thread, studies have shown that chemical changes are happening. See the study tristanj linked, http://pubs.acs.org/doi/abs/10.1021/acs.est.6b01741

Thats the huge asterisk.

A successful vaporization requires temperatures of 150-200°C with a max of 250 for self-experimenting enthusiasts.

So when these studies include the chemicals caused by pyrolysis, they're not studying realistic e-cigarette use.

A good analogy would be studying the consumption of improperly distilled alcohol that included methanol- EXCEPT you wouldn't be able to taste the methanol in bad liquor, and you'd absolutely be able to taste burnt e-liquid.

I'd still have to imagine that the acetaldehyde and formaldehyde intake is a small fraction of what the average persona already ingests in the form of alcohol.

Which of course doesn't mean it is good for us but I think establishes that the danger from that is probably less scary than that sounds

It's "potentially" because a study in the lab cannot demonstrate health outcomes. (Which, of course, requires people to be involved.) It's also wise to attach it to single studies: we don't tend to change views based on single studies, but on large amounts of studies that corroborate each other.

So, yes, I agree: this warrants much further study. I have not come to any conclusions, but I have updated my priros. But, independent of that, I felt some comments in this thread were misrepresenting what the research did.

The flavors must make some sort of difference. I have an e-cig. Not a huge user, but I notice that the resistors clog up a lot faster with the darker juices and last a lot longer with the clear ones. I am mildly concerned about the effects that they might have on health - because when I got it I had read stuff similar to your "two to three chemicals" line also saying that its essentially the same as an asthma inhaler, when the reality is somewhat different.

Even if e-cigs are equally harmful on a per-quantity basis (which I'm still somewhat skeptical of), an advantage over regular cigarettes is that you can consume less than one full cigarette at a time.

Are there statistics or studies on how much one average person consumes from an e-cigarette compared to a regular cigarette?

100% anecdotal but the few people I know that use e-cigs are using them all day long. I'm just glad a lot of places treat it the same as smoking and ban it. Nothing worse than being in line with someone that thinks its cool to vape and blow huge clouds.

I smoke slightly more with ecigs than I did with cigarettes and I use the vape throughout the day. But whenever I have a real cigarette now I get a head rush and feel the nicotine quite strong, which is the feeling I would previously get with the first cigarette after the numerous times I quit smoking and started again. Clearly I'm using far less nicotine with e-cigarettes, which surprised me because I didn't notice any side effects (additional "niccing") when I switched to vaping last yr.

So even if I smoke 30% more than I used to I'm probably consuming significantly less harmful chemicals in the end, including nicotine. Which means it will probably be easier to quit vaping than cigarettes, especially as I could taper the nicotine percentage from 6mg -> 0mg over a period of time without adjusting behaviour.

At 6mg -> 0mg I wouldn't say nicotine is a harmful chemical. It's a stimulant.

I don't think the debate is that nicotine is harmful in such quantities, but it's a terribly addictive stimulant generally consumed with varyingly harmful chemicals, so easing it out to zero helps in quitting inhaling those chemicals altogether.

Apart from the obvious bad manners implied by blowing huge clouds of smoke in a space where people are tightly packed, as in a queue; what problem do you have with e-smoke exactly? The smell?

The smell is often quite overpowering. I think "cloying" is the word; sometimes I feel like my airways are trying to close up.

This is literally stuff that's been inside a person's body being ejected out into my face. Now, I kinda agree that everyone is doing this constantly by simply breathing, but I don't really smell other people's exhaled CO2 so I'm ok with it. If it has odor and is visible, I WILL find it VERY rude and disturbing, to say the least.

I also find people's breath smelly on public transport. The reason is not just cigarettes but bad oral hygiene in general. Not sure what to do about it though...

On the other hand I hardly ever felt any vapour smell from e-cigarettes.

Also... Smoke is a mixture of gas and solid materials, while vapour is a mixture of gas and liquid.

I think using precise terms in a debate brings extra clarity into it, so instead of inventing poetic proxy terms, like e-smoke, let's just use the more commonly understood word "vapour" instead.

I also don't know what's in the smoke. It might be harmless, might be absolutely awful for you. Doesn't help that my friends have used the excuse "it's just vapor".

excuse?

With a smell allergy, I've had e-cigs (and perfumes, which I lump in the same category) near me induce everything from coughing and sneezing fits to migraines and vomiting.

I knew a friend with a much, much worse smell allergy where a smell of the right color dye would cause seizures and possibly kill them.

Whoa, I'm not alone! I can't handle most perfumes or scents (in addition to a number of things). Nowhere near as bad as your friend, but I can get to the point where breathing gets hard.

Anecdotally: my mother frequently smokes regular cigarettes, she'll light one for a few 'puffs' then put it out.

To combat this, tobacco companies put some sugar on the filter tip and I believe better tobacco in the very tip of the cigarette, this way the first hit is better than all of the others.

If you smoke anything in parts, it's well worth it to learn to purge. It's a cigar trick, you basically slowly blow through the cigar for a few seconds and it improves the taste and slows the burn for a while.

It might just be the placebo effect that makes it taste better after, but who cares?

I smoked cigarettes in the past and used ecigs to make cessation easier. When I switched, I used the vape more than cigarettes, but I also had a lot easier of a time quitting the vape(due to the lack of MAOI I believe). Even if people vape more than smoke, it may be worth it if they use it to successfully quit smoking altogether.

What, ordinary cigarettes have monoaminoxidase inhibitors?!

Yes, as a component of tobacco, and it's basically the reason that tobacco is addictive

http://www.jneurosci.org/content/25/38/8593

In my personal experience more.

I read a study showing that the absorption rate of nicotine is about half through an e-cigarette, because of other chemicals in normal cigarettes that increase the rate.

The same can be said for pipe tobacco.

I went to an 80 year old's birthday party recently and he has been smoking since WW2 or thereabouts. His advice - get a pipe and buy tobacco from a proper tobacconist. In that way he avoids all the chemical horrors of regular hand rolling tobacco. Normally this stuff has flavours in it, stuff to make it burn and stuff to keep it moist. The difference is huge.

My advice to the government is to ban adulterated tobacco products so only dry rolling tobacco is for sale. Then to apply a minimum age to buy tobacco with this age rising one year every other year. In a relatively short period of time tobacco will become as rare as pipe smoking is.

Most of the harmful chemicals aren't additives, they're combustion products that would be there no matter how the tobacco is cured and processed.

Alternate anecdote: my grandfather smoked pipe tobacco for as long and died of heart failure complications due to lifelong nicotine usage, after already dealing with lung cancer-related illness.

Pipe tobacco isn't that much "safer", either.

Of course the cigarette companies are investing in the e-cigarette business, like Philip Morris with IQOS. Smoking is a dead end so they are looking for alternatives.

Ultimately, like smoking, using e-cigarettes is smelly and unhealthy. Regulators aren't going to allow for them to be presented as harmless because they aren't and science isn't going to ignore the harmful effects because they do exist. The only reason e-cigarettes are not banned in all the places cigarettes are is because the rules are about burning tobacco and politics makes it difficult to change the rules.

heart disease (not lung cancer) is the number one threat from smoking cigarettes. is that the type of dna damage that leads to heart disease? thats the question I'd like to know.

It also takes advantage of the fact that most people will assume they are referring to cancer.

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