# Forbes: Double Standard: E-Cigarettes Vs. Medical Marijuana



## Alex (31/7/15)

*Double Standard: E-Cigarettes Vs. Medical Marijuana*
by Sally Satel
Forbes.com


Did you read about the new review paper on medical marijuana published in the prestigious _Journal of the American Medical Association_? In case you missed it, the paper gave a less-than-ringing endorsement of marijuana’s therapeutic benefits.

I was surprised by the anemic media coverage. It should be of national interest given that 23 states, in addition to the District of Columbia, have legalized medical marijuana. According to the _JAMA _findings, many of the conditions for which medical marijuana is being officially used, from spasticity associated with multiple sclerosis to sleep disorders, are supported at best by either “moderate quality” data – as the report put it — or “low quality” data across the 79 randomized, placebo-controlled trials reviewed by researchers.

I found only CBS News and Reuters covered the report as hard news and the _Denver Post_ published an editorial (“Moment of Truth for Medical Marijuana”). These are big outlets, to be sure, but they are conspicuously modest in number. By contrast, the media can be relied upon to cover potentially harmful effects of vaping. In January, for instance, the _New England Journal_ _of Medicine _published a report entitled “Hidden Formaldehyde in E-Cigarette Aerosols.”

Media coverage ensued: “E-cigarettes Can Churn out High Levels of Formaldehyde,” read the NPR headline. “E-cigarettes can Produce More Formaldehyde than Regular Cigarettes,” warned the _Los Angeles Times_. “Before You Vape: High Levels of Formaldehyde Hidden in E-Cigarettes,” cautioned NBC News. “Study Links E-Cigarettes to Formaldehyde, Cancer Risk,” said _The Wall Street Journal_. The _Baltimore Sun, __Associated Press__ (appeared in Washington Post), __Reuters__ (appeared in Scientific American), _and CBS News also picked up on the _NEJM_ report.

The NEJM authors’ notable conclusion was that vapers are endangered by formaldehyde in the course of normal use. More specifically, the authors showed that when a vaping device was heated at high voltage settings – that is, overheated — the emitted vapor contained the carcinogen formaldehyde at five to 15 times the concentration found in cigarette smoke.

But – and this is key — no user would ever actually heat an e-cigarette high enough to produce the recorded levels of formaldehyde in the study. The resultant vapor (known as a “dry puff”) would be intolerably irritating to the throat. Indeed, when the _NEJM_ researchers tested the same device at a voltage level normally used by vapers, they detected no formaldehyde.

Then, in May, a study in _Addiction_ confirmed that formaldehyde in vapor poses no danger at normal heat settings. Toast is a handy analogy here. “Most toasters have a setting which burns the toast to a crisp,” wrote Peter Hajek of the London School of Medicine and Dentistry in _Addiction_. “Although burned toast contains carcinogen, it is highly unlikely that _New England Journal of Medicine_ would publish a paper demonstrating this and warning people that toasts are carcinogenic.”

I could find no mention in the mainstream media of the_ Addiction _study, however, apart from the comment sections of specialty medical or vaping blogs. Like the unfashionable _JAMA_ paper on medical marijuana, which ran counter to the generally benign national attitude towards marijuana, the reassuring article on formaldehyde did not jibe with the growing view that vaping is somehow harmful. While no strong, organized lobby opposes medical marijuana, such vocal and visible entities as the Centers for Disease Control, the California Department of Health, the American Lung Association and the Campaign for Tobacco Free Kids routinely denounce e-cigarettes, insisting that the devices will renormalize smoking in society and serve as a “gateway” to smoking for teens. To date, the vast bulk of evidence regarding smoking and vaping patterns suggests that neither fear has materialized.

And it’s not just a media double standard for medical marijuana and e-cigarettes that exists. The government has just made it somewhat easier for researchers to explore the effects of medical marijuana use, while nothing has been done to make clear a path to conduct randomized clinical trials on difficult e-cigarettes as therapeutic (i.e., smoking cessation) devices.

In mid-July, the Obama administration moved to facilitate randomized clinical trials research on medical marijuana by lifting the burdensome requirement that researchers submit study proposals to the U.S. Public Health Service for review. This step in the four-step research-approval process, it turns out, added another layer of review that contradicts an FDA review requirement. The streamlining will help a bit, although other hurdles (e.g. obtaining marijuana samples for the study from the National Institute on Drug Abuse ) do remain.

Meanwhile, the route to randomized clinical trials research on e-cigarettes remains blocked.

Let’s say, for example, a researcher wants to learn if people with schizophrenia, a population which smokes at triple the rate of the general population, succeed in switching partially or completely to vaping. The researcher is stuck. Why? Because in order to compare e-cigarettes to other forms of cessation interventions, the FDA requires an Investigational New Drug (IND) application. And completing the application requires the researcher to submit information on the chemistry of e-liquid as well as manufacturing and control information. Gathering these data is time consuming, if doable at all, given the scores of producers, many of whom are based overseas.

If researchers cannot investigate e-cigarettes as a smoking cessation tool, experts cannot definitively respond to one of the major objections of critics who claim e-cigarettes have no demonstrated therapeutic effect. There is massive evidence from individual smoker self-reporting that e-cigarettes enable users to quit smoking or to cut down markedly–a recent example is here–but few rigorous or realistic head-to-head comparisons with patches and gum.

Last February, a group of four research organizations, including the American Association for Cancer Research and the International Association for the Study of Lung Cancer, wrote a letter to then-FDA Commissioner Margaret Hamburg protesting this Catch-22. “This regulatory hurdle makes clinical research with most if not all commercially available products impossible because scientists do not have access to the required information that would allow them to obtain IND applications,” they wrote. Studies already approved by NIH review committees and in some cases funded by the NIH or FDA, cannot move forward.

So we find ourselves in an environment where research on e-cigarettes, a technology with the potential to spur a transformation in tobacco smoking is being stymied, and where news of its promise is considerably less headline-worthy than dubious evidence of its harm. Yes, marijuana, too, may have therapeutic value–we simply need better quality evidence. Too bad e-cigarettes don’t enjoy the same good will and favorable press coverage that, for better or worse, has been bestowed on marijuana.

_Sally Satel is a psychiatrist and resident scholar at the American Enterprise Institute._

_source: http://www.forbes.com/sites/sallysa...tandard-for-e-cigarettes-v-medical-marijuana/_

Reactions: Like 3 | Informative 3


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## gertvanjoe (31/7/15)

Nice work. You should have been a journo

Reactions: Like 1 | Agree 1


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## Alex (31/7/15)

gertvanjoe said:


> Nice work. You should have been a journo



I don't take any credit for this bro, it's all goes to the original author *Sally Satel @ Forbes*

Reactions: Winner 1


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## kev mac (1/8/15)

Alex said:


> *Double Standard: E-Cigarettes Vs. Medical Marijuana*
> by Sally Satel
> Forbes.com
> 
> ...


Other than being a shill for big tobacco, just what's with the hard on some folk have with ecigs?

Reactions: Like 1


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## Alex (1/8/15)

kev mac said:


> Other than being a shill for big tobacco, just what's with the hard on some folk have with ecigs?



The pharmaceutical companies stand to lose the most due to losses in future smoking related treatment drugs, and of course the current NRT products.

The governments stand to lose out on all the tobacco tax revenue, coupled with having to deal with ex-smokers living longer lives into retirement.

The politicians and NGO's who stand to lose out on funding.

And lastly the tobacco companies.

Just off the top of my head...

Reactions: Like 1 | Agree 1


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## Vainga (14/12/21)

Electronic cigarettes are almost as harmful as regular cigarettes. They look a lot like hookah in effect, and it's still nicotine, right?

Reactions: Disagree 4


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## DarthBranMuffin (14/12/21)

Vainga said:


> Electronic cigarettes are almost as harmful as regular cigarettes. They look a lot like hookah in effect, and it's still nicotine, right?



Hello @Vainga 

Just noting that you are replying to a thread from 2015, a lot of water has gone under the bridge since then and in the UK (where you are based currently according to your profile) they have found that Electronic Cigarettes used for Vaping (not THC or CBD) is 95% safer than smoking. 
Further to this, the NHS has allowed for the opening of Vape shops in some of their hospitals as a pathway to smoking cessation.

Naturally anything other than inhaling oxygen is bad for you, but you when it comes to nicotine you are actually consuming nicotine through some of your food sources as well. Anything used in excess can be bad for you and yes, Nicotine is an addictive chemical. Yet, not everyone vapes high nicotine e-liquid and some even vape without nicotine.

I would suggest you read up on some more recent publications and posts in regards to vaping. Also, this is a Pro-Vaping forum.

And no, electronic cigarettes are not Hookah's. You can find electronic hookah's if you are interested in it, but I don't think you'll find it here.

Reactions: Agree 1 | Winner 3


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## Munro31 (14/12/21)

Vainga said:


> Electronic cigarettes are almost as harmful as regular cigarettes. They look a lot like hookah in effect, and it's still nicotine, right?


Are you a vaper?

Reactions: Like 2 | Agree 1


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## Adephi (14/12/21)

Vainga said:


> Electronic cigarettes are almost as harmful as regular cigarettes. They look a lot like hookah in effect, and it's still nicotine, right?


You came to the wrong neighborhood.

Reactions: Agree 6


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## zadiac (14/12/21)

Munro31 said:


> Are you a vaper?



Obviously not.

Reactions: Like 1 | Agree 3


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