E-Cigarettes: Health Risks

With the look and feel of real cigarettes, electronic cigarettes are experiencing a boom in popularity. But as the product's popularity rises, so do the unknowns about its potential impact on public health.
As scientific studies on e-cigarettes attempt to catch up with their popularity, it remains to be seen if the products will be a boon to smoking cessation or a setback toward the goal of cutting out nicotine for good.

E-cigarettes are battery-powered devices that convert nicotine into vapor. The products are sold over the counter and are not subject to the same regulation as actual cigarettes. A 2011 survey showed that about 21 percent of smokers had used e-cigarettes at least once — up from about 10 percent of smokers who took the same Web survey in 2010, according to a Centers for Disease Control and Prevention study published online in February in Nicotine & Tobacco Research. About 7 percent of smokers who received the same survey in 2010 via postal mail also said they had tried e-cigarettes at least once.

The Food and Drug Administration announced in 2011 that the agency plans to propose regulating e-cigarettes as a tobacco product, according to Jennifer Haliski, a public affairs officer for FDA's Center for Tobacco Products. Any product containing nicotine from tobacco, unless marketed for therapeutic purposes, is considered a tobacco product, according to the 2009 court case, Sottera Inc. v. Food and Drug Administration.
However, concrete regulations on e-cigarettes have yet to be issued, as the science is still catching up.

"Further research is needed to assess the potential public health benefits and risks of electronic cigarettes and other novel tobacco products," Haliski said.
Getting regular smokers to quit is a potential public health benefit of e-cigarettes, said Maciej Goniewicz, PhD, an assistant professor of oncology at the Roswell Park Cancer Institute's Division of Cancer Prevention and Population Sciences.

Goniewicz said that so far he sees e-cigarettes being mostly used by regular smokers — rather than first-time smokers — as an alternative to smoking cigarettes, offering another chance to quit after a relapse. Goniewicz is one of five authors of a Nicotine & Tobacco Research study published online in April 2012 that compared nicotine and organic compound vapors of 16 e-cigarette brands available in U.S., United Kingdom and Polish markets. The study found 300 puffs of e-cigarettes labeled as having high nicotine levels delivered 0.5 to 15.4 milligrams of nicotine — considered negligible compared to toxins in regular cigarettes.

However, Goniewicz said there is limited data about whether what is exhaled from e-cigarettes contributes to exposure for people besides the user.

"We know there's almost nothing there compared to cigarette smoke," Goniewicz told The Nation's Health. "But we don't know what's going on after a very long exposure. We need to wait for the studies."

Regular use of nicotine, which is found in tobacco, is not without its own health effects. An addictive substance, nicotine use can lead to increased blood pressure and heart rate as well as nausea, sweating and diarrhea, according to the National Institutes of Health. E-cigarettes are not the only product to deliver nicotine to users. A variety of products are used to provide nicotine to users as a tool for smoking cessation, but such tools are regulated by FDA.
FDA-approved over-the-counter cessation products include nicotine replacement chewing gum, lozenges and skin patches. In addition, FDA regulates prescription drugs that block nicotine's effects on a smoker's brain.

Tim McAfee, MD, MPH, director of CDC's Office on Smoking and Health and an APHA member, said it is reasonably certain that if someone who smoked a pack a day switched completely to e-cigarettes it could represent a benefit to health, but there are still many "caveats and 'buts' around that."

One concern is the use of e-cigarettes in businesses or restaurants to skirt clean air ordinances or indoor smoking bans, McAfee said. Use of e-cigarettes in places with established indoor smoking laws could be a step backward for public health when it comes to air quality, as well as a negative for someone who may have otherwise quit nicotine, he said.

"Someone should not have to go in a restaurant and wonder what's coming out of a plastic device that is completely unregulated," McAfee said. "And we know that nicotine comes out, which is not fair to expose people to in a public space, since nicotine is a psychoactive substance."
In Washington, D.C., two members of the Council of the District of Columbia are not waiting for more studies before proposing regulations.

Council members Yvette Alexander and David Grosso introduced legislation April 9 to classify e-cigarettes as regular cigarettes that are already prohibited in indoor areas in the city.
Alexander, who chairs the Council's Committee on Health, said her council staff told her that they had seen people using e-cigarettes inside city bars and restaurants. On a subsequent trip to a convenience store to find one, a man told Alexander he had searched for the device in a quest to quit smoking, she said.

"These e-cigarettes are marketed in one way in that if you want to smoke you can smoke indoors," Alexander told The Nation's Health. "You can beat the ban by smoking these e-cigarettes, that's one marketing tool."

Alexander noted that e-cigarettes are also touted as an alternative for people trying to quit smoking. However, it is uncertain if they are less addictive than traditional cigarettes.
"Everyone is up in arms that I'm trying to ban the e-cigarettes," Alexander said. "I'm just trying to ban them as the same way tobacco products are banned indoors. If you want to purchase them and smoke them in places where you can smoke tobacco products, that's fine. But we just want to maintain the ban on tobacco products for indoor use."

Another potential public health concern is how the product is marketed toward teens and young adults. According to CDC, teens who use smokeless tobacco are more likely than nonusers to smoke cigarettes, which is a trend CDC's McAfee said he does not want to see replicated with e-cigarettes.
Jennifer Pearson, PhD, MPH, a research investigator at the Schroeder Institute for Tobacco Research and Policy Studies at the American Legacy Foundation, said that e-cigarettes are a novelty product for young adults, along the lines of hookah. Pearson is a co-author of a study on e-cigarette awareness published in the September issue of APHA's American Journal of Public Health.

"It's (seen as) something fun, different you can do when you go out and something you can do in the clubs because you're not going to get kicked out," Pearson said.

E-cigarettes continue to evolve, with new models in the absence of federal regulation. Goniewicz said that rather than limit access to the product, he would prefer that regulations ensure quality and safety and prevent advertising to children.

"My point of view is that we still have cigarettes, and this is the main problem," Goniewicz said.

Pakistan accounts for 80% of polio cases: WHO

In what is a serious threat to India, Pakistan has recorded 206 cases of paralysis caused by wild polio virus in 2014.

This is the highest number of cases on record by October in Pakistan in its history.

Nineteen new wild polio virus type 1 (WPV1) cases — the deadliest strain were reported in the past week in Pakistan.


This brings the total number of WPV1 cases in 2014 to 206 compared to 39 in 2013 by this date.

The most recent case had onset of paralysis on September 22, in Khyber Pakhtunkhwa.

WHO is now worried that the virus could soon be imported by close neighbours India.

The 10th meeting of the Independent Monitoring Board (IMB) of the Global Polio Eradication Initiative (GPEI) held in London recently concluded that the goal of stopping global polio transmission by the end of 2014 will be missed because of the worrying transmission in Pakistan and active export of the virus to other countries. 

According to WHO, Pakistan now accounts for nearly 80% of polio cases globally and is now the "greatest single risk" to eradicating the crippling disease due to a ban imposed by militants on immunization.

"Pakistan remains the greatest single risk to the achievement of global polio eradication," WHO said.

The situation is primarily due to a lack of access to children for vaccination, largely owing to a continuing ban on immunization imposed by militants in the North and South Waziristan, and insecurity and killing of polio workers in the field".

WHO admitted that currently Pakistan appears likely to become the last polio endemic country in the world.

This poses a serious threat to neighbours India which was in March 2014 declared polio free.

The WHO has also confirmed that poliovirus from Pakistan has spread to Israel, West Bank and Gaza, and Iraq.

Poliovirus also spread from Pakistan to Syria, causing a major outbreak during the country's civil war.

IMB confirmed that it "cannot conclude that the grip on polio control is yet sufficiently strong. This is particularly because with just four months remaining until the 2014 deadline for stopping polio transmission, Pakistan has little hope of meeting this deadline, and Nigeria, with impending elections, is at real risk of losing the vital opportunity".

WHO says "Pakistan's situation is particularly problematic. Its polio control programme is years behind that in the other endemic countries. As currently constituted, the structure of the Prime Minister's Polio Monitoring Cell does not allow effective action against polio. A much stronger form of management and co-ordination is required".

"It is an indictment of this country's programme that even in the easier eradication context of the low season, Pakistan has almost as many cases in the first 4 months of 2014 as in the whole of 2012 - and 9 times as many as in the same period in 2013.

While some progress has been made in Peshawar, Karachi and Quetta, this is not sufficient to stop poliovirus transmission. It is vital that the prime minister and president urgently activate an emergency body with the resources, power and capability to transform this grave situation," WHO has said.

The deadline for global polio eradication has been repeatedly postponed and each time missed: the deadline years of 2000, 2004 and 2012 have all passed without the ultimate goal being reached. 

EBOLA OUTBREAK IS GETTING RACIST

The first time a reporter asked a CDC representative whether Thomas Duncan — the first patient to receive an Ebola diagnosis in the US — was an American citizen, the question seemed pretty tame. One could excuse it as a general inquiry about the Duncan’s nationality during the first press conference announcing his diagnosis. But after the CDC declined to answer, the question kept coming. "Is he a citizen?" reporters repeatedly asked. "Is he one of us?" they meant.

The current Ebola crisis has been tinged with racism and xenophobia. The disease rages in West Africa, and has therefore largely infected people of color. But somehow Americans were among the first to get a dose of Zmapp — the experimental anti-Ebola drug — this summer, despite the fact that Africans have been dying from the current Ebola epidemic since its emergence in Guinea in December. There are a lot of reasons for that, of course. The drug is potentially dangerous and only exists in short supply. It’s also extremely costly. And it originated in Canada, so it's unsurprising that North America controls its use.

And now that Ebola has "reached" the US, American privilege — white privilege, especially — is floating to the surface, in even less subtle ways.

The difference in treatment for US patients and African patients is stark, beyond the use of experimental drugs. Some Ebola-stricken regions in West Africa don’t have access to fuel to power ambulances, and many health workers lack the protective gear to stave off infection. Which is why it's so strange that Duncan's health has been used as an excuse to voice concerns about the presence of foreigners in Dallas. Instead of asking government officials why the WHO has a much smaller budget than the CDC or why it has suffered massive cuts in the last two years, Americans have preferred to focus on themselves.

Yesterday, The Raw Story wrote about how immigrants living in the same neighborhood as Duncan’s family were facing immense discrimination. Some have been turned away from their jobs, David Edwards writes, while others have been refused service in restaurants. The color of their skin and their accents makes them a target, even though they never came into contact with Duncan, and therefore pose zero risk. It doesn’t matter: they’re dark-skinned and foreign. They’re in Dallas. They might be infectious.
Now, an ugly new hashtag has emerged: #Obola, a coinage that was popularized thanks to a tweet by conservative writer Dinesh D’Souza, and a Michael Savage radio segment. If you don’t get the reference, I don’t blame you. The President’s name doesn't exactly resemble "Ebola." But D’Souza, a known "birther," has somehow managed to liken a name like Obama with a disease that’s raging in Africa — not in the US. Predictably, this has given racist xenophobic Americans a banner to rally around.

America: your xenophobia is showing. Many have lost sight that the only way to become infected with Ebola is by coming into contact with the bodily fluids of someone who’s showing symptoms. Others have ignored the fact that, so far, no one who came into contact with Duncan has developed symptoms of Ebola. Instead, there are calls for larger quarantines in Dallas — or a continent-wide one in Africa — which would only lead to more infections, and a greater sense of panic.
 
Ebola is scary because it causes quick, gruesome deaths. But it isn’t easy to transmit. Had we acted sooner, had we prevented the WHO’s budget from being cut, we probably wouldn’t be dealing with such large numbers of infected people now. It’s not like we don’t know how to stop Ebola — we’ve done it in the past. That’s what we should be talking about. We should be asking why the first case of Ebola transmission outside Africa happened in Spain, a country that recently experienced public health cuts.
We’re playing catch-up, and the CDC is optimistic. But when people spend more energy on dehumanizing individuals in Dallas than on urging politicians to help the people of Liberia and Sierra Leone, we all lose out.
 

iMAC RETINA 5K

Apple’s newest iMac has a Retina 5K display, which Apple says is the highest resolution display on the planet. The new screen is, as you might expect, gorgeous at first sight, and prolonged exposure only heightens the experience. And even as someone who’s used to using a Retina MacBook Pro as his main machine, it’s a big step up.

The screen shows full resolution photos with zoomed crops that look better than most originals coming out of the camera, and the iMac still features that tapered design that narrows to 5 mm at its thinnest point. Apple’s existing industrial design on the iMac has aged well, but the screen is the real star here, and it’s honestly a little hard to pay attention to the rest as a result.

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As someone who works with images and video on a daily basis, I can immediately see the advantages of owning a Retina 5K Mac, even over and above the arguably more powerful Mac Pro. Apple has beefed up the internals with faster processor and graphics card options here, however, and it should have enough juice to handle 4K video editing, which it can also do at full resolution while also offering you a fully featured app window with controls and settings in Final Cut Pro.

Apple’s clearly not positioning this for the average computer user – $2,499 is a lot less expensive than high-end 4K TVs at comparable sizes, and this is a full computer, so that’s definitely a good deal. But it’s still a big investment, and one that most people in the market for an all-in-one will probably balk at.

Just like with the Retina MacBook Pro, Apple’s looking to start this tech out as something aimed at pros and serious enthusiasts first, but make no mistake – eventually, Retina will bleed to lower cost lines, and it’s definitely the future of desktop computing.