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Study: Unlike e-cig vapor, cigarette smoke contains deadly carbon monoxide

Scientists from three major American universities have released a new study which indicates that the lack of carbon monoxide in e-cigarette vapor makes them substantially less harmful than smoking.  Since the rise in popularity of vaping in 2015, anti-vapers and Big Tobacco lobbyists have been spreading disinformation and confusion surrounding the concepts of nicotine.  Yes, both combustible tobacco cigarettes and many vaping products contain nicotine, but only the former produces both tar and carbon monoxide.

The co-authors of the research quote Michael Russell, a pioneer in the field of tobacco harm minimization.  In a 1976 study entitled Low-tar medium-nicotine cigarettes: a new approach to safer smoking (PubMed), Dr. Russell is famously quoted as saying, “People smoke for nicotine but they die from the tar.”

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The more recent study ed by Dr. David Abrams of New York University in collaboration with other tobacco control experts at the University of Vermont and the University of Nebraska, builds upon the decades-old Russel data.  The Abrams group point out that – not only is nicotine non-carcinogenic – there is no known links between nicotine consumption and the many documented respiratory, cardiovascular, and pulmonary diseases associated with smoking.  In the Abrams-led research entitled Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives (NCBI), the co-authors issue the following statement.

“For most smokers, there is little evidence that nicotine itself causes any of these classes of disease when decoupled from smoke (see details in Niaura et al., 2016…Although nicotine use poses some risk for cardiovascular disease, it is dwarfed by the risk posed by smoking cigarettes...Nicotine itself does not appear to cause cancer, even in former smokers who use low nitrosamine snus for decades…Smokers switching to vaping have experienced improved lung capacity and less frequent asthma…Evidence also indicates that nicotine itself is relatively safe when obtained from CDER-approved over-the-counter NRT (nicotine replacement therapies), widely used for smoking cessation.”

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By highlighting the overwhelming misconception that nicotine and smoking are one-in-the-same (they are not), the Abrams team lays the groundwork for their deeper analysis of cigarette smoke composition. Just like tobacco smoke is laced with tar, a thick, gooey substance that clogs the arteries, respiratory airways, and lungs, it also produces a carbon monoxide gas.  Like inhaling the fumes of an automobile’s exhaust, carbon monoxide can be potentially lethal.  E-cig vapor is both tar- and carbon monoxide-free.

“E-cigarette aerosol is very different. E-cigarettes do not contain any tobacco and do not produce carbon monoxide. The harm continuum emphasizes a key point: It is not that e-cigarettes are completely safe, or even the safest nicotine-containing product available, but that they are much safer than smoking. NRTs are safe enough that CDER approved them for over-the-counter consumer use more than two decades ago. Long-term use of NRT has been endorsed as an acceptable strategy to reduce morbidity and mortality from smoking.”

Throughout their dissertation, the co-authors regularly lambast public health officials who consistently spread disinformation about vaping.  The Abrams group takes issue with those who conflate vaping with smoking, smoking with nicotine consumption, and nicotine consumption with cancer development. 

In other words, smoking is not vaping, nicotine consumption is not the same thing as smoking, and those who ingest nicotine are not necessarily more likely to develop cancer.  To amend the former quote by the great Dr. Russell, “People smoke for nicotine but they die from the tar…and the carbon monoxide.”

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