The promises and threats of e-cigarettes

Can cigarettes ever be healthy? The manufacturers and distributors of e-cigarettes claim that this latest import from China called “e-cig” is the healthiest alternative to real cigarettes that you can ever have. It is said to have the following advantages (Source: The official site of electronic cigarette smoking):

• E-cig has no fire, no tar, no carbon monoxide, no ash, no stub. The CEO of Smoking Everywhere tells CNN that e-cig does not contain any of the substances that cause cancer.
• It lets you enjoy those tactile taste sensations without the risks associated with smoking and tobacco.
• You can smoke e-cig without polluting the environment or passing on second hand smoke, thus circumventing the anti-smoking bans in bars and restaurants.
• “It can help you to quit nicotine without giving up the smoking habits.” It supposedly works just like a nicotine patch does but with the satisfaction of the oral fixation.
• E-cig even comes in different colors and different flavours.

Many people however are wary and sceptical about the product for the following reasons:

• E-cig hasn’t been tested on humans and no safety data, short-term as well as long-term are available. The claims of manufacturers of e-cig being safe and healthy are actually not supported by scientific evidence.
• E-cigs come in no less than 30 different flavours ranging from strawberry to chocolate to peppermint. The candy-like falors can be confusing for children especially those that do not resemble cigarettes and can prove lethal when ingested. It can also send the wrong message to adolescents, luring them to try “healthy smoking.”
• It puts to test current smoking legislations in place, from anti-smoking bans to minimum age limit or purchase and possession of cigarettes.
• Its claims of helping people to quit smoking are suspect. In fact, it can actually worsen the nicotine habit.

How does an e-cig work?

Basically an e-cig consists of 3 parts: an atomization chamber, a nicotine cartridge (the mouthpiece), and a lithium battery. When it is turned on, the tip of e-cig glows, the liquid nicotine is vaporized with propylene glycol and the vapour is released at the other end into the smoker’s mouth.

What do the health authorities have to say?

In September last year, the World Health Organization (WHO) ordered that unproven therapy claims of e-cigs should be stopped. “The electronic cigarette is not a proven nicotine replacement therapy.” Some countries have declared e-cigs as illegal.

Currently, the US FDA is “hazy” about e-cigs, according to CNN. The regulatory body is not sure how to classify e-cig - as a device or as a drug. “The FDA is trying to halt importation of e-cigs, but isn’t seizing products already being sold in the United States“, says CNN.

Video: http://www.youtube.com/watch?v=QTrO-doyQBQ

               

Smoking ads then and now

It was about 13 years ago when I and my then fiance (now husband) flew to Japan to attend a friend’s wedding. Although I am Asia, this was my first trip to Japan and my first close contact with Japanese people. Our flight was co-chaired by Air France and Japan Airlines. I was so surprised but also annoyed that on the plane, the demarcation between smoking and no-smoking areas were not respected by the passengers. I have been on many intercontinental flights before but this was the worse when it came to cigarette smoking. I was to learn that many Japanese, despite their well-known discipline in work, cleanliness among others, were practically helpless against nicotine addiction.

In the same way, it was very surprising for everybody that the supposedly less disciplined Southern Europeans (Italy, Spain; and France) managed to get their anti-smoking regulations in place 4 to 5 years ago while there supposedly more disciplined northern neighbors are still playing catch up. Germany only implemented the law last year. In Switzerland, the law is in place in some areas but in others and Austria still has to decide which way to go.

In this post, I give you a couple of YouTube videos to look at to see how times have changed (definitely for the better) in terms of cigarette smoking. It also gives us an idea of how little did we (we being everybody including doctors) know about the serious health effects of cigarette smoke.

1949: More Doctors Smoke Camels Than Any Other Cigarette

http://www.youtube.com/watch?v=gCMzjJjuxQI

Steve McQueen cigarette commercial

http://www.youtube.com/watch?v=3Ogu3773PFE

 

Smoking On Airplanes - What were we thinking?

http://www.youtube.com/watch?v=6_caR1bkOEg

 

“What Were We Thinking?” — Doctor’s Office

www.youtube.com/watch?v=zEIkQSFRZ4A

               

The carcinogens in third hand smoke

It is an undeniable fact based on irrevocable evidence. Cigarette smoke is bad for our health and can cause cancer. Cigarette smoke contains more than 4000 chemicals, and 250 of these are poisonous gases and other toxic chemicals, according to this New York Times article. According to Cancer Research UK, cigarette smoke contains at least 69 carcinogens. Some of these are listed below.

• Tar - a mixture of dangerous chemicals
• Arsenic - used in wood preservatives
• Benzene - an industrial solvent, refined from crude oil
• Cadmium - used in batteries
• Formaldehyde - used in mortuaries and paint manufacturing
• Polonium-210 - a highly radioactive element
• Chromium - used to manufacture dye, paints and alloys
• 1,3-Butadiene - used in rubber manufacturing
• Polycyclic aromatic hydrocarbons - a group of dangerous DNA-damaging chemicals
• Nitrosamines - another group of DNA-damaging chemicals
• Acrolein - formerly used as a chemical weapon

Remember Polonium 210? It was the radioactive material used in the well-publicized 2006 murder of the Russian ex-spy Alexander V. Litvinenko.

Now, we know the hazards of first and second hand smoking. But here’s something newly recognized - and just as dangerous - third hand smoke.

So what’ third hand smoke?

According to this study recently published in the journal Pediatrics, “third hand smoke is residual tobacco smoke contamination that remains after the cigarette is extinguished.”

It seems that long after smoking is finished, long after the cigarette butt has been thrown away, the toxic substances in the cigarette smoke persist and stay, sticking to your clothes, hair, the furniture, the curtains, the carpet, the car upholstery. This means that by simply taking away the smokers and opening the windows does not make a room “smoke-free.”

In these days where smoke-free legislations have become widespread in developed countries, there are concerns about the possible increase of smoking in the privacy of the home, thus creating an environment full of second and third hand smoke. Unfortunately, the people most highly susceptible to toxic substances in the cigarette smoke are children. A little baby in its smoker mother’s arms, the little one crawling on the carpet, the toddler hiding behind the curtain or the school-aged child in the back seat of the car. They are exposed to the abovelisted carcinogens even if Mom or Dad never smokes in their presence through third hand smoke. This is why there is now a discussion going on about banning smoking at home.

This survey polled people’s opinion on third hand smoke and home smoking bans. A large majority of people, non-smokers as well as smokers are well aware of the hazards of third hand smoke. However, as expected, it is easy for the non-smokers to say “yes” to home-smoking ban than the smokers.

Nicotine addiction is a very hard habit to kick and I’m sure many smoking parents are doing their best to protect their children from the hazards of cigarette smoke. Unfortunately, short of quitting, they can’t really get rid of the threat of cigarette smoke.

I am all for home-smoking ban but this should be coupled with educational drives and smoking cessation help and support. In marginalizing smoking parents, we are also marginalizing their children.

               

It’s not the weather, it’s your lifestyle

Winter time is a difficult time for many people. It’s cold, dark, and gloomy. No wonder winter is associated with high incidence of depression.

Currently available data indicate that depressed individuals have a 50% higher risk for cardiovascular disease than those without psychological problems. Guidelines issued by American Heart Association (AHA) and endorsed by the American Psychiatric Association recommend that cardiac patients be routinely screened for depression. In addition, treatment of depression is commonly addressed during cardiac rehabilitation. In related previous posts, depression among heart patients were shown to be best tackled with a combination of psychotherapy and physical exercise.

But - we cannot blame the weather for everything. Researchers at the University of College London report that the wrong lifestyle leads to psychological distress, which in turn result in increased risk for cardiovascular disorders. In addition, the findings of the current study “suggest that treating psychological stress on its own might not be the best approach to reducing the risk of cardiovascular disease.”

The study used data from the Scottish Health Survey (SHS) which followed up 6576 adults aged 30 years and above fo7 seven years (on the average). The researchers measured psychological distress as well as behavioral and pathophysiological risk factors. The measurements were based on the General Health Questionnaire (GHQ-12), an assessment tool which basically looked at general levels of happiness, depression and anxiety, and sleep disturbances.

The results showed that

“…behavioral factors, including smoking, physical activity, and alcohol consumption, accounted for 65% of the relationship between psychological distress and cardiovascular disease risk. An additional 19% of the association was explained by pathophysiological risk factors, such as hypertension and C-reactive protein (CRP).”

The role of smoking and physical activity seems especially significant. People who were stressed of psychologically distressed tended to be smokers who little or no exercise at all. “These two factors alone explain well over 50% of the association between distress and cardiovascular risk.” Surprisingly, alcohol explained only a small part of the psychological distress - cardiovascular risk link.

The study results indicate the association between psychological distress and cardiovascular risk can be largely explained by behaviour and lifestyle factors, in this case, cigarette smoking and physical activity.

If your goal is to treat mental illness for the purposes of reducing cardiovascular risk, you need to take a fairly broad approach and not just look at the psychological components,” lead investigator Dr Mark Hamer (University College London, UK) told heartwire. “You need to also look at the behavioral risk factors as well, with a particular emphasis on physical activity and smoking cessation.”

Now that we are about to enter the New Year, maybe it’s time to reflect on our lifestyle. Is there anything we can change for the better? For better mental and physical health?

               

Nicotine and cancers (yes, that’s a plural)

The direct link between cigarette smoking and lung cancer is well-established. But what about other types of cancer?

Nicotine is one of the major components of tobacco and can be found in high concentrations in the blood and the urine of cigarette smokers. Although not considered a full-blown carcinogen that promotes tumor development, it is however suspected to have a growth-enhancing effect on existing cancer cells. This post looks at recent research on the link between nicotine and different types of cancer.

Nicotine and breast cancer

This study published in Cancer Research, a journal of the American Association for Cancer Research suggests that nicotine can have a potentiating role in tumor development. The researchers demonstrated through a series of lab test

“… that breast epithelial-like MCF10A cells and cancerous MCF7 cells both express several subunits of nAChR (nicotine receptor), that when bound, initiate a signaling process, potentially increasing cell growth and migration.”

As a carcinogen, nicotine does not seem to act alone but rather combines with other carcinogens with disastrous effect. According to the researchers, “…nicotine, possibly through perturbing cell cycle checkpoints, potentiates tumorigenesis in mammary cancer-prone or cancer cells.”

Aside from promoting the development of breast cancer, nicotine as a cocarcinogen is also linked to the spread of cancer through tumor migration from the breast to other organs.

Nicotine and bladder cancer

In another study, Taiwanese researchers observed that nicotine can de detected in significant quantities in the urine of cigarette smokers. The study aimed to investigate “whether there is nicotine-induced bladder epithelial cell proliferation and to identify the signaling transduction pathway regulated by nicotine.” The results suggested that nicotine exposure is a major risk factor for bladder cancer.

Nicotine and apoptosis

Apoptosis is a process wherein our body destroys unwanted cells. It is sometimes called “programmed cell death” and is protective mechanism that can protect us from cells that might potentially turn harmful (e.g. cancerous). Several studies suggest that nicotine may have some adverse effect on apoptosis. This recent study by Stanford University researchers showed that continued smoking during cancer treatment can lead to resistance to chemotherapy among lung cancer patients due to the anti-apoptotic effect of nicotine.

Nicotine in the gastrointestinal tract

This study by Chinese researchers show that nicotine can have some “aggravatory effect on … gastric mucosa injury” induced by the bacteria Helicobacter pylori, one of the major causes of gastric ulcers.

Nicotine effect on different human cancer cells

This study by researchers at the H. Lee Moffitt Cancer Center and Research Institute tested the effect of nicotine on different types of human cancer cells. The results show that aside from an inductive effect on lung cancer cell lines, it also induced proliferation of and invasion by breast and pancreatic cancer cells.

Photo credit: stock.xchng

               

Mommy’s smoking can hurt baby’s heart

Smoking? Want to be pregnant? If so, then you should read this.

We’ve had several posts regarding the cardiovascular health issues of smoking be it firsthand and secondhand. It is important to be aware that smoking can also hurt the unborn baby in a smoking woman’s womb.

Researchers found evidence that there is a link between congenital heart defects and smoking not only DURING but even BEFORE the first trimester of pregnancy.

The study looked at more 7,014 babies, 3,067 of whom had nonsyndromic congenital heart defects and 3,947 had none. They also looked at the smoking habits of the mothers and classified them as follows:

• Nonsmokers
• Light smokers (14 cigarettes per day or less)
• Moderate smokers (15 to 24 cigarettes a day)
• Heavy smokers (25 cigarettes per day or more).

The results show that women who are heavy smokers have two times the risk of having babies with septal heart defects compared to non-smoking mommies. Septal heart defect is usually a condition of having a hole in the septum, the tissue that separates the left and right chambers of the heart. In the same way, moderate smokers have 50% higher likelihood and light smokers have 44% higher likelihood of giving birth to babies with this type of heart defect. Other types of heart defects also occur more frequently in babies born to smoking moms than to non-smoking moms. These study results were not dependent on other factors that may also be linked to birth defects such prenatal use of vitamins, alcohol intake, age of the mother, and ethnicity.

Congenital heart defects (CHDs) are the most prevalent and serious of all recognized structural birth defects, occurring in 8 to 10 of every 1000 live births in the United States. Affected infants who survive often require repeated surgeries and lengthy hospitalizations, and many will have a lifetime of disability that imposes a significant burden on families. In the United States, CHDs result in billions of dollars being spent each year on medical care.

It is not often easy for women to quit smoking during pregnancy even if they want to. In such cases, the use of smoking cessation medications is recommended. However, according a survey, very few women take this option, unless it is openly discussed with their obstetrician or covered by health insurance.

So if you are a smoker and are planning to get pregnant, please consider seriously about quitting. And if quitting doesn’t work, ask for professional help. Remember, it’s your baby’s heart that is at stake.

 

Sources:

 

PEDIATRICS Vol. 121 No. 4 April 2008, pp. e810-e816.

Obstetrics & Gynecology 2008;111:348-355.

Photo credit

               

Quitting smoking benefits your blood vessels – fast

This good news is according to researchers who studied 104,519 women as part of the Nurses’ Health Study for over 16 years (1980 to 2004).

Participants in the study were categorized based on their smoking habits as:

• never smokers
• past smokers
• current smokers (1 to 14 cigarettes per day)
• current smokers (15 to 24 cigarettes per day)
• current smokers (25 to 34 cigarettes per day)
• current smokers (35 or more cigarettes per day)

The researchers looked at the deaths and whether they were caused by coronary heart disease (CHD), cerebrovascular disease (CVD), respiratory disease, chronic obstructive pulmonary disease (COPD), cancers, or other causes.

The researchers found encouraging results, at least when it comes to cardiovascular disorders. Past smokers are less likely to die from CHD and CVD than current smokers and this benefit was evident within 5 years of quitting.

“61% of the full benefit of quitting in regard to CHD mortality and 42% of the full benefit of quitting in regard to cerebrovascular deaths was realized within the first five years of stopping smoking.”

This reminds me of my trip to Venice in the spring of 2005. It was just weeks after the smoking ban in all public places, including restaurants and bars was implemented in Italy. I was very sceptical then whether they could really pull it off. Like many from Western Europe, I was always had this belief that southern Europeans tend to lack discipline. But I was surprised when I had an almost smoke-free Italian experience on that trip. France and Ireland followed suit shortly after.

In contrast, neighboring Western European countries known for their discipline and high health standards are laggards in this issue. Germany has just enforced the law in some of its federal states this year while politicians in Switzerland are still battling to pass the smoke-free law.

According to the 2008 Cardiovascular Disease Statistics of the European Heart Network, smoking kills 1.2 million people in Europe every year and 450,000 of these are due to cardiovascular disorders brought about by smoking.

Earlier this year, the European Society of Cardiology reported a significant decrease in cardiovascular events in France and Italy since the smoking ban was implemented in these countries. 

15% decrease in admissions to emergency wards of patients with myocardial infarction and strokes in France

11.2% decline in acute coronary events reported in Rome

Look how much can change for the better in just 3 years!

According to Dr Stacey Kenfield, lead author of the study

“The harms of smoking are reversible, but for some causes of death, the reduction takes many years, so it’s never too early to quit smoking. On the other hand, for some diseases-eg, CHD-there is a rapid decline in risk, so it’s never too late to stop smoking, even if you’ve been smoking for many, many years”.

 

Photo credit

               

Stress and Smoking

Many smokers start or continue their habit in order to deal with stress. But quitting smoking increases stress itself. That double-whammy makes it doubly hard to stop. Understanding what creates stress and finding healthier ways to deal with it well help in that struggle.

At low dosages, nicotine is a stimulant. It increases heart rate and raises the blood pressure. Those biological changes interact to produce psychological ones. They’re perceived, up to a point, as pleasurable. At higher levels, nicotine induces a relaxing state.

Both those effects tend to alleviate stress. Stimulation generates alertness. That gives a positive feeling, induced to a degree by the dopamine generated in the brain, along with other changes to its pleasure centers. Inducing relaxation has a clear and direct influence on stress level.

Yet, physiologically, stress or anxiety and feeling the exhilaration of challenge are very similar. The key to the difference lies in how we evaluate the external events and the reactions to them within ourselves.

Few external events, if any, are inherently stressful. It depends on how we evaluate their potential impact on our goals and values. Yet, the facts that lead to that evaluation are real. The loss of a loved one, the risk of losing a job, even everyday situations such as someone changing lanes rapidly in front of us on the highway are all potentially stressful. There’s a high likelihood those will negatively impact what we want.

Turning to cigarette smoking to deal with that stress is, in part, substituting a chemical for a change in attitude.

We can, for example, conclude that everyone on the road is rude and dangerous. But that’s obviously an overgeneralization. Most people don’t take foolish risks on the road most of the time. The risk of lower income from losing a job can happen. But we might also get another, even better, job in a day or a week.

It’s difficult to take that positive attitude right at the moment of quitting smoking. That’s one of the reasons only about 6% of those who stop succeed long-term on their first try. One thing can help: build up that attitude before reaching for a cigarette. Work on it while engaging in the habit.

Look to events that are often associated with lighting up, even when they don’t directly involve stress. An after meal cigarette can be delayed. Delay it longer and longer each day or week. Before long, that one is eliminated from the daily nicotine dose.

Build a more long term solution to stress by saving a small part of your income each week or month. Let it lay in an account collecting interest. Small amounts build up over time and provide a cushion to fall back on if the job does disappear. That lowers the stress at the moment, but also all the time you’re saving. Knowing that money is there now in case it’s needed later reduces the stress that can come from imagining the worst in the future.

Look for ways to reevaluate situations that cause stress. No one becomes stoic overnight. Nor is the attitude that ‘nothing matters’ helpful, either. Some things do and should matter. But slowly building confidence in one’s ability to meet challenges successfully reduces the odds and frequency of stress.

That program eventually reduces the felt need to smoke, and increases the odds of being able to quit permanently.

               

Corporation Charges Employees $100 a Month for Smoking

Looks like a lot more people are going to be adding “Quit Smoking” to their New Year’s Resolution list for 2008.

According to Michael Miner at the Chicago Reader, employees at Chicago’s Tribune Company who smoke or have a family member who smokes will be charged an extra $100 a month unless they sign up for and complete the Free & Clear smoking cessation program.  The new policy, which will be implemented on January 1, serves the dual purpose of encouraging better health and offsetting the high cost of employee health care coverage.

When I signed up for health insurance at the university I used to work at, individuals were offered a discount if they were non-smokers.  While smoking status was self-reported and relied solely on honor, us non-smokers considered it a nice “perk” for staying healthy.  My smoking colleagues, however, didn’t find the discount large enough to motivate them to quit.  Perhaps the high financial cost of smoking will start to clue employees at the Tribune Company into the high health costs as well.

For more resources on how to quit smoking, check out Cancer Commentary’s coverage of the Quit Smoking Counter.

Do you think that the Tribune Company is infringing on smokers’ rights?  Let us know in the comments!

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Research Roundup: New Developments in Cancer, 12-1-2007

Welcome to the weekend!  Grab a hot cup of coffee, and read the newest research developments in cancer this month in your pajamas:

Actually, make that a steaming mug of the herbal stuff:  Gloria over at Cancer Commentary (and of course, Battling Arthritis)  has more information on how to enroll in a green tea prostate cancer prevention study going on right now at Moffit Cancer Center.

Check out her post at “Moffit is Looking for Green Tea Study Participants.”

Can a computer predict whether a patient will undergo side effects from drugs like chemotherapeutics?  That’s what scientists at the University of California-San Diego aimed to find out.  From the Public Library of Science: 

The study, reported November 30 in PLoS Computational Biology relates to a class of drugs known as Select Estrogen Receptor Modulators (SERMs), which includes tamoxifen, the most prescribed drug in the treatment of breast cancer.

Unexpected side effects account for one-third of all drug development failures and result in drugs being pulled from the market. Typically drugs are tested using an experimental method which aims to identify off-target proteins that cause side effects. The team in this study, led by Drs. Philip Bourne and Lei Xie, propose a computational modeling approach. If broadly successful the approach could shorten the drug development process and reduce costly recalls.

See: “A New Computational Technique Predicts Side-Effects of a Major Cancer Drug.” Also Related: “Personalizing the Math:  New Cancer Progression Model Individualizes the Numbers.”

If that’s how much it costs for the insured, just imagine how much it is for the UNinsured:  The Wall Street Journal reports that with average insurance caps that can fall below skyrocketing hospital bills, insured patients can end up paying out much more than they expect:

Part of the problem is that insurance caps — the maximum amount of a patient’s medical bill insurers will pay — haven’t been keeping pace with rising costs. The story says the average cap is $1 million per person, the same as it was in the 1970s.

See:  “Even With Insurance, Hospital Stay Can Cost a Million.” 

Also Related: “25+ Financial Assistance Resources for Cancer Patients, Survivors, and Caregivers.”

Talk to kids early about not smoking — REAL early:  That’s what Dr. Martha Tingen of the Medical College of Georgia thinks, anyway.  She just received a $2.5 million National Cancer Institute grant to implement anti-smoking strategies to fourth-graders in urban and rural Georgia.  From the Medical College of Georgia:

“Every day in Georgia, 84 kids between 10 to 13 years of age start smoking cigarettes,” says Dr. Tingen. “Ninety percent of all smokers start before they are out of high school. If we can help keep kids from smoking before they get out of high school, they probably won’t ever start. I am hoping the fourth graders haven’t started smoking, but I am thinking a lot of them still are exposed to tobacco use and second-hand smoke in the home.”

See:  “Anti-smoking Strategy Targets Fourth-Graders, Parents in Rural and urban Georgia.” Also Related: “Smoking is BAD for you?”

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