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Dr Laugesen was the first medical professional to state directly that it is impossible for ecigs to cause lung cancer. He was the the first professional medical researcher to investigate vaping in 2009 / 2010 (that is, vaping as in the use of battery-powered liquid nebulisers utilising PG, glycerine and water as the excipients - not vaporising of tobacco in an HnB type of process). His resource site is at: <span class="qlink_container"><a class="external_link" data-qt-tooltip="healthnz.co.nz" data-tooltip="attached" href="http://www.healthnz.co.nz/Publicnsall.htm" rel="noopener nofollow" style="background: url("//qsf.ec.quoracdn.net/-3-images.new_grid.external_link.svg-26-aef78ead48f1f1e2.svg") right 0.3em / 10.5px no-repeat; color: #2b6dad; padding-right: 15px; text-decoration-line: none;" target="_blank">Dr. Murray Laugesen's Publications</a></span></div>
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He is regarded as the among the most prominent public health researchers and longest-serving anti-smoking harm professionals in the southern hemisphere.</div>
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Since those early days in vaping, others have confirmed his opinion: there is no smoke and therefore the principal risk is absent; there are no other compounds present in vapour in sufficient quantity to pose any significant risk.</div>
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<b>Junk science</b><br />
There are enormous funds available for any researchers prepared to find ways to attack vaping, in order to protect the astronomical sums the smoking economy generates - as a $1.5 trillion a year sub-economy, there are many players who need to protect it by preventing smokers quitting or switching to other products.</div>
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High five-figure and low six-figure sums are frequently on offer to the research community to anyone who will produce studies that appear to put vaping in a poor light.</div>
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The principal value of junk science of this type is the media exposure that can be generated pursuant to the publication of the study, and its leverage by others to attempt to create an environment in which fewer smokers will attempt to cease smoking. Junk science is highly successful for this purpose and has high value for all the players who make so much money from smoking.</div>
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Recently, two research papers were published that reported large quantities of formaldehyde measurable in ecig vapour, and an elevated risk for cancer was mentioned in connection with these studies. However all such studies have turned out to be fraudulent in one way or another:</div>
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<li style="margin: 0px 0px 0px 2em; padding: 0px 0px 0.7em; position: relative;">They operated variable power hardware at excessive power levels that produced smoke as a result, and no vaper would want to inhale such products, or would be able to inhale such products at all, and certainly not for the multiple decades of daily use that might lead to cancer initiation.<br />This information was omitted from or purposely misrepresented in the associated press releases, which achieved wide publicity as a result.</li>
<li style="margin: 0px 0px 0px 2em; padding: 0px 0px 0.7em; position: relative;">Or: they did not actually find any formaldehyde <i>per se</i>, but precursors or associated compounds such as hemiacetals that cannot be honestly described as formaldehyde.<br />However, this information was omitted from or purposely misrepresented in the associated press releases, which achieved wide publicity as a result.</li>
<li style="margin: 0px 0px 0px 2em; padding: 0px; position: relative;">Nobody bothered to mention that formaldehyde is always present in the lungs anyway, in small amounts: it is a normal compound found in exhaled air; and this amount is increased for diabetics. The amount of formaldehyde diabetics exhale can be significant. It does not appear to be the case, though, that non-smoking diabetics are at elevated risk for lung cancer.</li>
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<b>The value of the subsequent media furore</b><br />
Note that the press releases, and especially the lurid newspaper articles that follow them, often bear no relation to the data reported in the clinical study. This happens too often to be a mistake - it is tempting to consider the main reason for these studies is to produce media propaganda that is not factually related to the study data, and secondly to punt for grants for more of the same.</div>
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Their purpose appears to be an attempt to get more and larger grants by the means of inflammatory press releases that have value for commercial actors trying hard to protect cigarette sales from any threat. This is a successful financial model because one of these junk science creators then received a grant of $3.5 million. The sums involved are not petty by any measurement - it is clearly a case of lies for cash, and a great deal of cash too.</div>
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<b>Other risks</b><br />
The question of other or more esoteric cancers has not yet been addressed, and cannot be until about a 30 year+ data resource is available; so it requires another 20 years before this can be answered honestly. At present it does not seem as if any disease vectors at all are visible. We have 70 years of data on PG inhalation without any significant issues; and the giant pharmaceutical companies are currently advising B2B customers to move into glycerol excipients for inhalable medicines, as there appears to be even less potential for the minor and temporary throat irritation issues and so forth that affect PG as the base for inhalable treatments and therapies (<i>search: Dow Optim</i>). In rare cases, intolerance to PG can present in the form of skin issues, and even more rarely, negatively affect prior existing tinnitus. This has not been a significant issue in a medicinal base inhaled for multiple decades in asthma inhalers and the like [1], before the relatively recent change to glycerol as the most popular excipient in inhalable therapies.</div>
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The two possible threats associated with vaping are the trending use of higher temperatures, possibly leading to the creation of thermal degradation products; and the inhalation of food flavours. A significant amount of research is being done in these areas. In general there is a good research base from which to evaluate potential issues with ecigs: several hundred studies (a comprehensive PubMed search shows 400+) [<i>Q4 2016 update: 1,000+</i>] and even more lab analyses, leading to a possible total of over a thousand single sources in this area (<i>2018 update: thousands</i>). A paucity of research does not exist: there is a plethora.</div>
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What is missing is long-term health data. It simply will not be available until 2025 or later. Current indications are that ecigs are an ultra-low-risk THR consumer product (Tobacco Harm Reduction) [2] of the clean nicotine delivery system class. The best way to describe such products is the EEV or electric/electronic vaporiser, rather than e-cigarette, as that is just a highly-successful marketing term that has no relevance to advanced products that are medium or large-format battery-powered liquid aerosol generators with no resemblance or connection to cigarettes.</div>
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Early models of EEVs were made to resemble cigarettes as this was the best way to market them to smokers. These micro devices are so inefficient they are no longer popular with vapers, apart from beginners in the process of converting from smoking (which can take some time).</div>
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<b>Dual use: a Very Good Thing</b><br />
Switching can be an instant achievement or it can take months. One of the unique benefits of vaping compared to any other switching strategy, cessation method or product type is the involuntary switching effect: a smoker may try vaping but have no plans to quit smoking. Over time, they vape more, and smoke less. They will probably graduate to better products than the beginner ecig type.</div>
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One day they find they haven’t smoked for some time and they are now vapers not smokers: an involuntary switch took place. This unique process has converted many smokers; it does not occur overnight, obviously, and requires time to complete, and therefore <i>many will be dual users for an extended time</i>. It is not unknown for this involuntary process to take 12 months although it is often shorter.</div>
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By definition, then, the majority of new vapers will be dual users - an excellent situation to be in since it is likely to lead to smoking avoidance or cessation (in practice the same thing, of course). A person who avoids smoking by switching to a THR product can expect the same health outcomes as a person who ceases smoking using a medically-approved route.</div>
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<b>Scale of risk</b><br />
As with any other product of any type, the individual may reduce or elevate risk according to their personal scale of risk/benefit values:</div>
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<li style="margin: 0px 0px 0px 2em; padding: 0px 0px 0.7em; position: relative;">People who vape a small amount daily (e.g. <3ml absolute="" an="" base="" be="" clearly="" clinically="" discernible="" elevation="" even="" hardware="" have="" health="" impact="" in="" irrelevant="" is="" it="" li="" low-power="" millions="" minimally-flavoured="" negative="" nicotine="" of="" or="" refills="" risk="" small="" so="" subjects.="" that="" to="" unflavoured="" unlikely="" which="" with="" without="">
</3ml></li>
<li style="margin: 0px 0px 0px 2em; padding: 0px; position: relative;">Those who vape very large daily quantities (30ml daily has been reported) of heavily-flavoured liquid of the type believed to have most potential for harm (custard flavours and similar, which probably contain diketones such as diacetyl or acetyl propionyl) in high-power rigs at high temperatures may be subject to similar risk elevations to daily smoking of a small number of cigarettes (although the types of potential morbidity will differ since the toxic compounds present differ).</li>
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For comparison, a teaspoon contains 5ml of liquid.</div>
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<b>Professional risk evaluation</b><br />
The gold standard for clinical evaluation of risk is the Cochrane Review. This is a risk analysis by a cooperating and comparative group of senior medics and researchers expert in the topic area, chosen for impartiality.</div>
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There is now sufficient research to enable such a review, and it currently reports that no significant risk is apparent. A Cochrane Review is also updated if new information becomes available.<br />
<span class="qlink_container"><a class="external_link" href="http://www.cochrane.org/" rel="noopener" style="background: url("//qsf.ec.quoracdn.net/-3-images.new_grid.external_link.svg-26-aef78ead48f1f1e2.svg") right 0.3em / 10.5px no-repeat; color: #2b6dad; padding-right: 15px; text-decoration-line: none;" target="_blank">http://www.cochrane.org</a></span><br />
<span class="qlink_container"><a class="external_link" data-qt-tooltip="cochrane.org" href="http://community.cochrane.org/features/new-cochrane-evidence-shows-electronic-cigarettes-facilitate-smoking-cessation" rel="noopener" style="background: url("//qsf.ec.quoracdn.net/-3-images.new_grid.external_link.svg-26-aef78ead48f1f1e2.svg") right 0.3em / 10.5px no-repeat; color: #2b6dad; padding-right: 15px; text-decoration-line: none;" target="_blank">http://community.cochrane.org/fe...</a></span></div>
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The review covers covers a certain style of evaluation of efficacy for a specific outcome, and associated risk; but its importance is better understood as an ultra-conservative method of stating that risk elevations currently appear minimal - because the research evaluated would certainly have been far wider than that cited as core to the study.</div>
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<i>2016 update</i>: the Cochrane Review has recently been updated, and the conclusions are the same - no visible risk to health from vaping.<br />
<span class="qlink_container"><a class="external_link" data-qt-tooltip="cochrane.org" data-tooltip="attached" href="http://www.cochrane.org/news/conclusions-about-effects-electronic-cigarettes-remain-same" rel="noopener" style="background: url("//qsf.ec.quoracdn.net/-3-images.new_grid.external_link.svg-26-aef78ead48f1f1e2.svg") right 0.3em / 10.5px no-repeat; color: #2b6dad; padding-right: 15px; text-decoration-line: none;" target="_blank">Conclusions about the effects of electronic cigarettes remain the same</a></span></div>
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<b>Current state of play</b><br />
Now that tens of millions of smokers have switched to vaping, it is clear that:</div>
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<li style="margin: 0px 0px 0px 2em; padding: 0px 0px 0.7em; position: relative;">Vaping works extremely well as a THR product attractive to smokers.</li>
<li style="margin: 0px 0px 0px 2em; padding: 0px 0px 0.7em; position: relative;">The epidemiologic resources will be significant in years to come.</li>
<li style="margin: 0px 0px 0px 2em; padding: 0px 0px 0.7em; position: relative;">No significant threat to health has been identified.</li>
<li style="margin: 0px 0px 0px 2em; padding: 0px 0px 0.7em; position: relative;">The THR approach is by far the most efficient way to reduce smoking once smoking prevalence falls to low levels; and is the only known way to reduce it past the 20% mark, due to the 20% Prevalence Rule.</li>
<li style="margin: 0px 0px 0px 2em; padding: 0px; position: relative;">Much of the moneymaking propaganda about nicotine has been revealed as fatuous rubbish since it was impossible to maintain with millions demonstrating it to be false [3].</li>
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<b>Comparative risk</b><br />
So, the short answer to your question is: apparently not - but come back in 2030; we may have discovered a trivial elevation of risk above absolute for unusual cancers resulting from ultra high temperature vaping that will not in any case be definable as clinically significant in number. It seems unlikely at this point, but who can tell when risk is close to but not equal to zero.</div>
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The inherent risk of vaping compared to smoking is at least three orders of magnitude lower: probably four orders in most circumstances; perhaps 5 OoM in some circumstances. Three orders of magnitude is 10x by 3, or 1,000.</div>
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It has already been established that deaths from vaping are likely to be zero or close to it; and any related mortality is likely to include co-morbidities including previously existing conditions caused by smoking. Since smoking reportedly kills 1% annually of those engaged in the activity (a rough number to estimate those who will die in any given year for current or past activity), which for illustration is 10k per 1m current smokers or 100k per 10m smokers; and since that figure in the UK is said to be 100,000 annually dying as a result of smoking; and since it is generally recognised by the UK’s senior medics that no person will die annually on a regular basis from vaping even with 10 million vapers; then the comparative risk of vaping versus smoking is negligible and indeed close to nonexistent as far as mortality is concerned.</div>
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<b>My viewpoint</b><br />
My evaluation of these data, studied in real time since 2009 based on global data reporting by consumers, is that the principal risk appears to be for minor elevation of risk for reversible stage 1 COPD; and some few persons will always encounter tolerance issues reversible by discontinuation of use.<br />
There is an issue of contra-indication concerning interactions for subjects receiving multi-therapy in the area of anti-depressants due to nicotine/pharmaceutical interactions.<br />
Interesting symptoms have been observed in smoking cessation and vaping initiation in thyroid patients pre and post diagnosis, but these have not resolved into contra-indication for vaping; rather, in observed smoking and cessation-related effects on thyroid patients and adjustment of meds dosages unrelated to vaping.</div>
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I have written the world's most comprehensive list of smoking cessation symptoms in the context of vaping, together with vaping-related intolerance issues encountered to date, which can be found at:<br />
<span class="qlink_container"><a class="external_link" data-qt-tooltip="e-cigarette-forum.com" data-tooltip="attached" href="https://www.e-cigarette-forum.com/forum/threads/a-list-of-symptoms-when-quitting-tobacco-and-changing-to-an-ecigarette.3305/" rel="noopener nofollow" style="background: url("//qsf.ec.quoracdn.net/-3-images.new_grid.external_link.svg-26-aef78ead48f1f1e2.svg") right 0.3em / 10.5px no-repeat; color: #2b6dad; padding-right: 15px; text-decoration-line: none;" target="_blank">A list of symptoms when quitting tobacco and changing to an ecigarette</a></span></div>
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I do not anticipate any major shocks.</div>
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[1] PG was widely used in asthma inhalers as an excipient in the past. There are better materials for this now, such as Dow's synthetic glycerol. The reason why PG is still popular in vape refills is because the astringency or throat tickle ('throat hit') it creates helps to mimic tobacco smoke, and this is very useful for smokers in the process of switching.</div>
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There is a strong move toward all-glycerol base ('100% VG') for vaping refills that parallels the move away from PG toward glycerol in inhalable medicines. However, we should consider the very useful antibacterial and antiviral potency of PG, and perhaps retain a small amount even in all-glycerine mixes - PG is one of the most powerful antimicrobial aerosols known.</div>
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Vapers widely note their reduction in colds and flu-type infections after switching; while some of this must be attributable to cessation of inhalation of smoke, some thought should be given as to whether the PG content of the refills commonly used by most vapers in the first year of vaping may also have some effect.</div>
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[2] THR or Tobacco Harm Reduction is the consumer choice of low-risk smoke-free alternatives to cigarettes, and (to a lesser extent) the public health policies that support such choices.</div>
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(If THR is employed medically, it becomes THM or Tobacco Harm Management -the medical term for it - since THR is exclusively a consumer process.)</div>
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Because the national health statistics of Sweden are unique in the developed Western world, we know that THR works spectacularly well. Sweden has the lowest tobacco-related mortality of any Western developed country by a wide margin, since half of tobacco consumers there do not smoke: they use a local product called Snus, an oral tobacco that has no statistically-identifiable association with morbidity or mortality due to its specialised manufacture. Thus, half of tobacco consumers in Sweden do not contribute to the mortality figures. Since these are mostly men, and women prefer to smoke, it means the male population derive the greatest benefit from this.</div>
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Sweden has the lowest male lung cancer and oral cancer rates in the EU.</div>
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Because THR has been so spectacularly successful in Sweden, we can expect similar benefits in those countries where vaping has so far enabled the largest percentage of smokers to switch, such as the UK - somewhere between 20 and 25% of smokers here have switched, and it may be possible that the UK achieves Sweden’s 50% switch rate at some stage; together with its attendant fall in tobacco-related morbidity and mortality to half of the 100% smoker rate after sufficient time has elapsed.</div>
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