Fear Based Content and Vaping
From heart medicine, to breakfast cereal, shampoo, sandwiches, vitamins and everything between, the presence of chemicals or toxic heavy metals in a product will always alarm consumers. It is reasonable to expect safety standards to be rigorously enforced, but the fact is that sensational headlines about “hidden dangers” also make great click bait.
Critics of vaping did not pause to consider the validity of the research when trumpeting the discovery of toxic metals in e-cig vapor
last February. In a case of classic confirmation bias, it told critics what they wanted to hear and was promptly accepted as gospel.
E-cigarettes and vaporizers are an easy target for this sort of attack. The concept of harm reduction is an anathema to a significant percentage of the population and there is an all too human tendency to disapprove of any activity that seems foreign or new. Iowa Attorney General Thomas Miller advocated harm reduction and criticized the new FDA regulations
on ecigs, but all too often the voices of vapers are drowned out.
A Higher Standard of Evidence
There is a major difference between the warnings about mac and cheese that flooded Facebook a few years ago and recent concerted attacks on electronic nicotine delivery systems: the price of the latter can be measured in lives lost.
Rather than customers not eating fresh because of long since removed “Yoga mat chemicals
”, you have smokers turning away from cigarette alternatives that have been shown to be less harmful[i]
because of suspect science and misleading headlines.
The Dose Makes the Poison
Our instinctual knee-jerk reaction to the presence of minute amounts of metals or toxins flies in the face of the most basic principle of modern toxicology: The dose makes the poison. This adage is credited to Paracelsus, a Swiss physician, astronomer and alchemist.
Alchemy not highly regarded today, but it could come in handy if the goal is to turn the leaden weight of a flawed John Hopkin’s University vaping study
into the scientific gold that major media outlets[ii]
made it out to be.
Our body is intricately designed to filter out environmental toxins at low levels, which we are constantly exposed to. Consider the different outcomes that result from hopping off a 1 foot curb 30 times and jumping from a third floor window. The human body is adapted to deal with one and not the other.
Low level exposure that is nowhere near the toxic threshold is seamlessly handled by your liver, much like a healthy musculoskeletal system can fend off one foot hops off from a curb. The Hopkin’s study supposedly demonstrated that exposure to metals from vaporizers was high enough to merit concern but this conclusion was only reached because of an enormous error.
Fundamentally Flawed Study
The early 2018 study by Hopkin’s study assessed the risks of exposure to toxic metals from vaporizers. The mechanism they described seems plausible enough on paper: Vaporizer of coils made from such diverse metals as titanium, nickel, kanthal, nichrome and steel are heated and leach into the vapor produced by the device.
It turns out that under closer scrutiny this hypothesis is completely unrealistic. This didn’t stop their flawed conclusions from dominating the headlines last winter. The hole in their theory was that to ingest the metal levels they described, you would have to venture far behind the normal daily use patterns of an e-cig or mod. In some cases, you would have stretch the very boundaries of reality in order to reach unsafe levels of toxic metals.
If a study that relies on unrealistic e-cig use to drum up controversy sounds familiar, it is because other studies attacking vaping as dangerous have also used preposterous scenarios to obtain the desired outcome. A notorious 2015 New England Journal of Medicine
(NEJM) study on formaldehyde in e-cig vapor relied on a similar sleight of hand. Their conclusions were effectively dismissed by a 2017 study in the journal Food and Toxicology
, but the damage to the reputation of e-cig safety remains.
It is worth noting that to obtain elevated formaldehyde levels in a laboratory setting, the NEJM study authors were generating dry puffs with ratcheted up power levels that vaper would never consider. The foul flavor and painful throat hit would make such a pattern of use nearly impossible.
The adage of the dose making the poison is important to keep in mind when reading headlines about toxins, a subject not limited to vaping. By appealing to fear, marketers will blatantly leverage ingredient lists, the use of chemical dyes and trace amounts of metals into sales gold. It is a proven way to scare potential customers away from the targeted company or products.
Rather than digging into some extremely contentious subjects that are beyond the scope of this article, it will suffice to point out that there is no easier way to discredit a product than to use the names of common chemicals and metals as snarl words. Whether such concerns are justified or not, the salient issue is that in the findings of the Hopkin’s study do not even fall in this gray area. The study is that flawed.
There are enough holes in this study to drive a truck through, but this was not mentioned in the breathless coverage of “dangerous levels” toxic metals that were purportedly found in e-cigarette vapor.
Zombie Myths That Never Die
The “metals in e-cig vapor” gambit is showing up in literature condemning vaping
and like a zombie it will presumably shamble forward long after additional research has killed it dead. Much like a misleading “popcorn lung” scare, and the NEJM formaldehyde study, expect this myth to live on forever.
Retractions Are Never Headlines
A research paper debunking the bunk Hopkin’s toxic metals study was recently released and it has not received even a fraction of the coverage that the original study did.
An immutable rule of journalism is that the retraction never gets the amount of column space that the original story did. This is especially true when there is motivated reasoning involved and biased parties want the initial, albeit inaccurate, conclusion to stand unchallenged.
Mistakes Found In the “Toxic Metals in Vapor” Study
The flaws in the John Hopkins “toxic metals in vapor” study were exposed by Greek researcher Konstantinos Farsalinos and Brad Rodu, University of Louisville professor of medicine. Their dismantling of the shoddy Hopkins study was published in Inhalation Toxicology
earlier this month.
The study concluded, “EC emissions contain trace levels of metals. For almost all metals, unrealistically high levels of liquid need to be consumed in order for total daily exposure to exceed established limits.” This matches the conclusions of a previous study in the journal Environmental Health Perspectives
that found, “with normal use, the daily dose of metals inhaled from second generation devices was below the daily safety limits for all metals.”
Rodu and Farsalino’s methodology was straight forward. Median and 75th percentile metal concentrations in e-cig aerosols were used to determine how much e-juice, measured in (g/d), would be required to exceed the permissible daily exposures for the toxic metals outlined in the original Hopkins study. The metals in question were aluminum, cadmium, chromium, copper, nickel, lead, antimony and tin. Rodu and Farsalinos then converted their results into grams of e-liquid consumed.
Rodu and Farsalinos may have relied on the same data set as the John Hopkins study, but they used a more sophisticated statistical model. As a result, their findings were far less alarming. This was due to a glaring flaw in the Hopkin’s study: the “toxic metals” were measured in terms of environmental exposure.
Environmental exposure is useful for measuring chronic low-level exposure that does not exceed threshold levels. This is hardly applicable to a device that is actively firing for between 5 and 10 minutes per day. If you are hooked up to respirator powered by e-juice or live in a floating cuckoo cloud castle of vapor, the Hopkins study may prove very informative, but keep in mind that us vapers on earth average only about 140 puffs per day[iii]
Take aluminum for example, which is the third most abundant element in the Earth’s crust. Despite being present everywhere, it is at the heart of several long standing conspiracy theories and has an exceedingly negative reputation. Including it on a list toxins, no matter how little may be present, is pretty much guaranteed to garner a lot of attention.
What Researchers Found
What Rodu and Farsalinos discovered about aluminum in e-cig vapor was that even at the maximum level of exposure reported in the study, the 75th
percentile, you would have to consume 1.5 million grams of e-Liquid in a single day to surpass the recommended safe exposure rate. An expensive habit to say the least, and the logistics of obtaining 1.5 tons of e-juice a day would challenge even the most resourceful vaper.
Calculating the exact cost of such a gluttonous habit is a bit tricky because specific gravity varies between e-Juices and this influences the grams to milliliter conversion. But expect to spend about a quarter million dollars a day. I would inquire about a volume discount.
How Much Would You Have to Vape?
Only nickel, chromium and lead were within reach for an actual human who vapes using the current technology available. For nickel, the median level was 73 g/day and 17 g/day for 75th percentile levels. 17g represents about 3 times the consumption of the average user. On the far end of plausibility were chromium, with respective levels of 358 and 68 g/day and lead 338 and 135 g/day.
For all other metals, the level of liquid consumption would have to be “orders of magnitude higher” according to the study’s authors. Here is a complete table of their results:
The Dangerous Influence of Flawed Vaping Studies
The John Hopkins study poisoned the well against vaping and lowered the level of discourse on the important subject of harm reduction. Myths about the vaping deter smokers from looking for alternatives and lives are lost.
The presence of dangerous toxins and heavy metals in vapor has become an article of faith among anti-vaping propagandists. It may not be possible to ever convince them otherwise. This does not mean we should give up trying to convince the fence sitters and those willing to rationally discuss electronic nicotine delivery systems. It just means that intractable opponents will use this discredited study as a talking point.
Don’t hesitate to shut them down with facts but don’t expect to change their minds. It is very hard to “unring” the bell when it chimes a message of fear, toxins and poison. Myths like these live on in zombie form and appear when least expected, wasting everyone’s time and distracting us from more important issues, such as how are minors accessing nicotine.
The FDA’s own numbers show that most teens are getting their nicotine through social contacts and not convenience stores. This did not stop regulators from making huge moves and here is a quick guide to the new FDA regulations
One thing we can say with certainty, even the most egregious violators of age verification rules don’t sell enough e-Juice to hit the ridiculous heavy metal dosage thresholds outlined by the Hopkins study.