E-cigarettes: lights and shadows

www.gea2000.org
FOGGIA, 20th March 2014 World Oral Health Day
Electronic Cigarette:
lights and shadows
Giacomo Mangiaracina
Faculty of Medicine and Psychology, Sapienza University of Rome
President of Agenzia Nazionale per la Prevenzione – Editor of “Tabaccologia” scientific review
Lidia Friederich
Certified Counsellor, Walla Walla, Washington State, USA

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Tribute to Confusion
Confusion is an undefined state of
knowledge that compels to the
conscious exploration of probable
hidden truths.
(Mangiaracina)

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Rite
Fault
Habit
Remedy
Vice
Risk
Abuse
Addiction
Tribute to Confusion 2
The history of tobacco
itself is the most acute
expression of confusion
in the social field and in
science.
Tobaccology is the
most rational answer
toward a much-needed
solution of the problem.

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“If my boss is taking drugs, am I a toxic-dependent?”
(Se il mio datore di lavoro si droga, io sono un tossico-dipendente?)
Tribute to Confusion 3

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1604: King James writes “A Counterblaste to Tobacco”.
1700: Bernardino Ramazzini, in “De morbis artificum diatriba”
recognized how smoke from tobacco could cause the same
diseases of the workers in coal-fired ovens.
1914: Sir Henry Hallet Dale studied the connection between
nicotine and acetylcholine and described in vivo effects on
experimental animals.
1950: Ernst Wynder showed the correlation between smoking and
cancer.
1962-1971: The Reports on Smoking of the Royal College of
Physicians (RCP), admitted that smokers could be
nicotine dependent.
Steps of awareness on tobacco

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1977: In the report from the National Institute on Drug Abuse (NIDA),
the director William Pollin, introduced the Tobacco addiction as
a "prototype of addiction."
1988: The major influence on the regulation of tobacco in the U.S. was
the publication of the Surgeon General's report entitled "The
health consequences of smoking. Nicotine addiction ".
1996: Working on the regulation of tobacco products, the FDA
concluded that "cigarettes are the most powerful tool to deliver
the drug nicotine."
David A Kessler et al., "The Food and Drug Administration's Regulation of Tobacco Products",
The New England Journal of Medicine, 1996:335, p.988.
Nicotine Addiction

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Since 1994, the "Nicotine addiction"
is nosologically coded among
pathological dependencies in the
DSM-IV and ICD-10
Nicotine Addiction

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Tobacco companies denied that Nicotine
was addictive at the Court of the United
States, until 1996, when Jeffrey
Weigand, the insider researcher at
Brown & Williamson, with the support of
the State of Minnesota, revealed the
findings of the research of those
companies that demonstrated Nicotine
was highly addictive.
So the Brown & Williamson, and other multinational tobacco companies,
were memorably condemned and fined for 386 billion dollars.
The art of organized confusion

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We still have so much
work to do…
...for instance, about
this strange tool that
is literally flooding
the market: the
“ELECTRONIC
CIGARETTE”.
...but there’s
something wrong!

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Not at all. A cigarette is
a roll of paper
containing tobacco.
Therefore, it is not a
cigarette.
Is this a cigarette?

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Not at all. It is indeed an
electrical device with a battery
and a resistance that heats up
through the flow of air intake.
Is it an electronic device?

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“Electronic cigarette” is, therefore, a conventional term. The
correct definition of this device is: Vaporizer (“Vaporizzatore” in
Italian). Consequently, their users would be vaporizers and not
smokers.
But with a “technical expression” were called ENDS: “Electronic Nicotine
Delivery System”.
That’s Wrong! It is not an electronic device and many of those
work without nicotine.
The only real absolute Nicotine Delivering System (NDS) is and
remains the cigarette.
So that the more conventional term friendly used to define them is "E-Cig".

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An example of incorrect information when you do not have
specific skills on the matter: to the question "electronic
cigarette is bad or not?" (Youtube), prof. Schittulli, President
of the Italian League Against Cancer, answered by talking
for 8 minutes in a vague and difficult way to understand.

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An example of correct information on television. Prof.
Umberto Tirelli, oncologist, states: "Electronic cigarettes are
not cancerous."

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A position that makes sense (mine): the high
taxation of the electronic cigarette does not help: it
discourages the use and contribute in maintaining
a stable market for tobacco.

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Produced by Japan Tobacco and Benson &
Hedges.
It is a device called “Pax by Ploom”, in which
the dried tobacco is heated to be vaporized.
Tobacco vaporizers

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Philip Morris has strategically chosen Italy to install a factory of excellence for
manufacturing electronic cigarettes with tobacco to be distributed in Europe. It
offers 600 jobs to young people.
The opportunism of tobacco companies
Who will dare
to protest?

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“The electronic cigarette is completely harmless, especially without
nicotine; therefore, for instance, it can be used in an official scientific
multicentric study involving three research institutes of Milan. The
electronic cigarette can be a very useful tool at the beginning of the quit
smoking process, especially for those people who have developed a
strong psychological dependence and repetition of gestures associated
with the action of smoking. These are some of the most difficult
components to eradicate in tobacco addiction.”
(Prof. Umberto Veronesi – Corriere della Sera)
We do not agree.
A statement of authority

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If Veronesi would have seen the results of our study
(2012), he would not have said that the e-cig is
«completely harmless», even though it sure is far
less harmful than the traditional cigarette.

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PM emissions of conventional cigarette versus e-cigarette at basal time
(T0), after 1,5’ (T1) and after 3’ (T2) of use of e-cig versus normal cigarette

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The devices deliver between 21 and 85% of
the nicotine contained in the liquid.
(MaciejL.Goniewicz etal, 2013)
15 e-cig puffs deliver 0.025 to 0.77 mg of
nicotine Vs 1.54 to 2.60 mg of traditional
cigarettes.
(Djordjevic,Stellman, &Zang, 2000)
Plasma levels of 0.74 ng/ml -6.77 ng/ml10
minutes after 10 puffs.
(HawkingL,CorcoranO,Psychopharmacology, 2013 )
E-Cig vs. Cigarette: NICOTINE
E-CIG DOES NOT CAUSE THE SPIKE OF
NICOTINE IN THE BRAIN

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Da Il Salvagente, 5-12 settembre 2013, da analisi dell’Università Federico II di Napoli
The study on heavy metals of University of Neaples

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TGCOM24

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Embryonic toxicity, hematologic effects
Flouris AD, and Coll. Acute effects of electronic and tobacco cigarette smoking on complete blood count. Food
Chem Toxicol. 2012 Oct;50(10):3600-3. doi: 10.1016/j.fct.2012.07.025. Epub 2012 Jul 31.
“Active and passive tobacco cigarette smoking increased white blood cell, lymphocyte, and
granulocyte counts for at least one hour in smokers and never smokers (P<0.05). It is
concluded that acute active and passive smoking using the e-cigarettes tested in the current
study does not influence CBC indices in smokers and never smokers, respectively.”

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No damage was observed from aerosols of propylene glycol in
Sprangue-Dawley rats, pigs and Beagle dogs. PG administration was
not shown to be responsible of any apparent damage of the tissue in
lungs, liver and kidneys.

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Effectiveness in smoking cessation
How to stop smoking with the e-cig

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Effectiveness in smoking cessation

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1. The e-cig is much less dangerous than traditional
cigarettes (vapor vs. combustion).
2. The e-cig can be helpful to smokers who want to
quit, but if used as a self-help way it is not very
effective.
3. It has a place in harm reduction strategies.
4. It should not be used in workplaces and all
enclosed places.
5. It should be banned from sale to minors.
A five-points conclusion

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Grazie.
Contacts:
giacomo.mangiaracina@uniroma1.it
facebook.com/mangiaracina
www.prevenzione.info
-I would like the last cigarette.
- Only if it is electric.Agenzia Nazionale
per la Prevenzione

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