Dr Konstantinos about the EU consultation on e-cigarettes…
Q: I know you have been following the European consultation on electronic cigarettes. Is this, in your opinion, a fair consultation?
A: The European Union wants to decide on the regulatory status of electronic cigarettes. To do that, they should first learn what this device is, how it works and how it is being used by the consumers. Then, they should be informed about the health-related issues and aspects, considering it not just as a new product and habit but as a method for smokers to reduce or completely substitute smoking. Both consumer organizations and scientists have a duty to inform the regulatory authorities.
The most important problem that I currently see is that e-cigarettes are considered and treated as yet another tobacco product. To understand that, just have a look at the experts invited to inform the EU. Besides Prof. Etter, none of the other well-respected scientists have ever been involved in research on e-cigarettes. Adding to the problem, these scientists made presentations which, although informative about smoking, were completely off topic concerning e-cigarettes. What was really unfair, and maybe dangerous, was the selective referral to negative studies and the selective presentation of negative data from studies which were in reality positive for e-cigarettes. This inevitably will lead to inappropriate decisions, because it does not serve the proper and extensive evidence-based education of legislators.
Moreover, I observed that some scientists simply oppose e-cigarettes because of ideology: they look like cigarettes and have nicotine, they say. Well, these are exactly the reasons why they are so effective! My opinion is that public health authorities have still not understood what e-cigarettes really are.
Q: You have carried out previous studies into electronic cigarettes, and are currently involved in a huge study of vapers. As an expert, were you invited to speak at the recent EU consultation on electronic cigarettes? If not, why not?
A: I was invited once, not by the EU authorities but by the Greek E-Cigarette Businesses Association, to present some research during a workshop in March. Unfortunately, the 3-minutes time provided to us by the committee was not only insufficient but rather insulting. E-cigarettes are simply a too important issue to be discussed in 3 minutes. I am sure thousands of smokers know how important issue it really is.
Interestingly, I kindly asked by e-mail to be included in the panel of presenters during the early May workshop, specifically listing the studies I have performed that could be informative for the European Commission. I had data about nicotine consumption from e-cigarette use, particularly in relation to tobacco cigarettes and nicotine inhalers. I never got an answer by anyone from the Committee. The reason for not been invited is probably because I have not been involved in any research on tobacco in the past. Again, this shows that they have not realized how different and revolutionary e-cigarettes are compared to any tobacco product. I prefer not to think that there is any other reason besides that…
Q: I understand the EU claims that insufficient studies have been conducted on electronic cigarettes. What studies are the EU calling for?
A: I think everyone agrees that we still have a lot to learn about e-cigarettes. This is not a surprise; we still don’t know everything about tobacco, which is used for centuries. Despite that, currently our knowledge about e-cigarettes has expanded compared to previous years.
We have sufficient data to conclude that e-cigarettes are by far less harmful compared to tobacco, and none can deny that. Of course, we need to find ways to make them more effective in substituting smoking and as safe as possible. We welcome any suggestion on what kind of research should and could be done, but none from the EU or from the panel of experts invited made any proposal or suggestion. Once again, this is evidence that they have insufficient understanding on the product and its use. The role of all of us already involved in e-cigarette research is to provide guides and information both to public health authorities and to the scientific community so that they will proceed with proper and realistic research. We can offer our experience from the daily communication with vapers, our deep understanding of the product and our insights into the “secrets” of e-cigarette science.
Q. According to one MEP, the EU are telling MEPs that there is substantial evidence that children are using electronic cigarettes as a gateway into smoking. I’ve not seen any evidence (in fact, recent surveys suggest the opposite). Have you?
A. No study has ever shown that e-cigarettes are a gateway to smoking. And I cannot understand how it could be. I mean, if someone wants to smoke a cigarette he does not need any gateway. It is much easier to use tobacco cigarettes instead of having to carry batteries, atomisers, chargers and related equipment. Inevitably, some children may choose to use e-cigarettes; a lot more are already using tobacco, so I think it would be better specifically for them if they were using e-cigarettes instead. But I don’t see it as a gateway to smoking. It could be a substitute for their current smoking habit. In any case, the authorities and the e-cigarette industry must make sure to avoid attracting youngsters or non-smokers to e-cigarettes. But some things are unavoidable; just search online to see videos of children smoking tea, chalk, smarties, twix and whatever you can imagine.
Q. An Italian MEP has recently tabled a question which highlighted concerns that electronic cigarettes are eating into tobacco revenues, and there are rumours that Italy is poised to start taxing Ecigs. What’s your reaction?
A. Tobacco taxes are (supposedly) imposed for funding the health system to handle the additional burden of smoking-related disease. My answer to the MEP is that he should not worry; he will probably observe significant health benefits from switching to e-cigarettes in the population. We have the example of smokeless tobacco in Sweden…
Q. Finally, could you tell us a little bit about the research you are working on presently.
A. This will be a very busy year. Over the next few days, the first ever study evaluating the cytotoxic potential of e-cigarette vapor on cultured cells will be published, with some impressive results. Moreover, 3 research studies have already been submitted in medical journals, and are under review for publication. I have been invited to the annual congress of the European Society of Cardiology to present the results of a new clinical study on the cardiovascular effects of e-cigarette. Another clinical study has been submitted for presentation at EUROECHO, the annual congress of the European Society of Cardiovascular imaging. We have also collected the data from another toxicological study on vapor, in which we tested some e-cigarette functions which have never been examined before. Finally, we have several research protocols under preparation, and we are looking for sponsors to fund these studies. Of course, we also have the internet survey. More than 18,000 participants till now, and it will be available until June 25. Then we will start the hard work of analyzing all these very important data.
Q. How can vapers and e-cigarette companies help out with your research?
A. I am really glad to say that vapers in Greece have been very supportive of our research. They have been very willing to participate in all our research projects, even when we performed some invasive procedures (like delivery of intravenous pharmaceuticals). Of course, all our research is vigorously examined by the ethics committee and we always get approval before initiating any protocol. The safety of all participants is always our first priority.
The e-cigarette industry needs to financially support some research projects. Of course we don’t expect this from the local shops, but there are already some big players who have the resources to boost research. If they have faith in their products they are welcomed. We cannot guarantee the results but we guarantee proper and sophisticated research that will increase our understanding of e-cigarettes. It is our ethical duty to inform the consumers about the products they are using. Some of the protocols we have prepared will break new grounds on e-cigarette research.
Thanks so much to Konstantinos for once again agreeing to an interview!