Monday, 6 October 2014

Passive vaping

Stanton Glantz has been pushing a study of nicotine exposure in the homes of e-cigarette users as a justification for banning e-cigarettes in 'public' places.

The study measured nicotine levels in smokers', nonsmokers' and vapers' homes. It also measured cotinine levels in the saliva of the people who live in them. Cotinine is a biomarker for nicotine and is often used as a proxy for tobacco smoke exposure.

Cotinine measurements were taken from people who did not smoke or vape. These were the results study reported:

The [geometric mean averages] of salivary cotinine were 0.38 ng/ml (GSD=2.34) in the smokers’ homes, 0.19 ng/ml (GSD=2.17) in the e-cigarettes users’ homes, and 0.07 ng/ml (GSD=1.79) in the control homes. Salivary cotinine concentrations of the non-smokers exposed to e-cigarette׳s vapour at home (all exposed ≥2 h/day) were statistically significant different that those found in non-smokers exposed to second-hand smoke ≥2 h/day and in non-smokers from control homes.

These results would have to be replicated before they are taken as gospel, but let's say that they are broadly correct.

You would only consider banning the use of e-cigarettes indoors if there was evidence that there was harm being inflicted on bystanders. Glantz assumes—or wants the reader to assume—that a raised level of cotinine/nicotine is indicative of harm. It is not.

Studies like this tend to ignore cotinine in smokers themselves, perhaps because they would provide some useful context. I have written before about the colossal differences in cotinine exposure between smokers and nonsmokers. A systematic review of cotinine readings found that the average smoker has a saliva cotinine reading of 318 ng/ml (and levels seem to be similar in e-cigarette users). This is so far off the scale of what can be found in passive smokers, let alone passive vapers, that it is almost impossible to show on a graph, but let's try anyway.

Smokers produce a thousand times more cotinine than the passive smokers in this new study and two thousand times more than the 'passive vapers'.

Now, we know that the amount of cotinine found in the saliva of smokers is indicative of harm because we know that smoking is bad for health. We know that smoking is bad for health because of epidemiological studies and other evidence, not because of cotinine readings. Cotinine itself is not harmful, nor is nicotine at these kind of levels, and therefore it is only because cotinine readings in smokers can be used as a rough proxy for exposure to the more dangerous chemicals in tobacco smoke that we can associate cotinine with harm.

But this only works if you are dealing with tobacco smoke. If you believe that there is no safe level of tobacco smoke exposure then you can believe that the amount of tobacco smoke absorbed by passive smokers, though orders of magnitude smaller than that absorbed by smokers, poses a degree of risk. Ultimately, that is a question to be settled by epidemiology.

What you can't do, however, is use cotinine as a proxy for dangerous chemicals in tobacco smoke when you are dealing with products that do not contain those chemicals. Glantz has made a basic category error.

Clearly, cotinine readings in the homes of e-cigarette users indicate the presence of nicotine, albeit at an extremely low level. Since nicotine does not cause harm to smokers when they are exposed to it more frequently and in vastly greater concentrations, there is no reason to think that it would cause harm to passive smokers or passive vapers. I'm not aware of any reputable scientist who argues for smoking bans on the basis of nicotine exposure, rather they argue for bans on the basis of exposure to other chemicals that are associated with nicotine in cigarette smoke.

But if you are not dealing with cigarette smoke, cotinine and nicotine are not—and cannot be—used as proxies for other chemicals because those chemicals are not present.

If that seems obvious, it is, but apparently it still needs to be said.


Jurie Botha said...

WEll, TBH - it is what we've come to expect from Stunted Glantz. Anything to push his ideology - lies, misinformation, misrepresenting facts are all standard practice to him.

I'd say it is safe to ignore anything that has his name on it.

paul mar said...

People like Glantz are getting desperate and the more desperate they get the more ridiculous things they come out with.

Not even Chapman believes in this crap

Leigh Whitaker said...

Question... Do smokers absorb cotinine, or is cotinine a byproduct of absorbed nicotine? In the post you speak of smokers absorbing cotinine, and I'm not sure that's true. It doesn't really affect the message, but I just thought I'd ask.

Jurie Botha said...

Leigh, please see:

It is a metabolite that acts as a biomarker for tobacco smoke. (Product of body metabolising Nicotine) As far as I can understand.

Christopher Snowdon said...


You're right. The body metabolises cotinine from nicotine. I'll amend the text.

Rursus said...

Don't forget the saliva cotinine levels in non passive smokers/vapers:

"In nonsmokers, the median concentration of cotinine was 2.4 ng/ml. The cotinine concentration was 1.5 times higher in nonsmokers whose close friends/spouses were smokers than in nonsmokers whose close friends/spouses were nonsmokers (p = 0.05)."

So... the mean level for an average nonpassivesmoker/nonpassivevaper is about 1,6ng/ml.

Christopher Snowdon said...


That study (from 2000) shows considerably higher levels amongst nonsmokers than are typical today (though still vastly less than seen amongst smokers), presumably because people were exposed to more smoke.

The findings for passive smokers in the study mentioned above are in line with a study from the UK before and after the smoking ban (see

Carl Darby said...

Why did they use geometric mean instead of arithmetic mean as their measure of central tendency?

Rursus said...

According to that study, the cotinine levels in nonsmokers/nonpassivsmokers are average 0.2 to 0.3 ng/ml after the smoking ban?

That perfectly fits ;)

PassiveVaper = NonPassiveSmoker = "normal" human being

JohnB said...

The idea of “passive smokING” (which originated in the Nazi era, by the way) is just another baseless inflammatory term. It’s just one of a plethora of antismoking delusions. There have even been jokes and comments made in films, for example, that a nonsmoker has “passive smoked” a pack a day.

The term “secondhand smoke” (highly diluted) is OK, but SH smokING or passive smokING are not. Antismokers believe that when they are exposed to SHS they are being forced to smoke, that they are effectively smokING. Being exposed to SHS, which is breathing air with highly dilute remnants of smoke, is nothing like smoking. Those who believe they are passively “smoking” have obviously never smoked a cigarette. Having never smoked, and therefore unable to tell the difference, they have been manipulated into the deranged belief that SHS exposure is equivalent to smoking. The quickest way to resolve the issue is to borrow a cigarette, light it, take a drag and inhale (drawback) the “packet” of concentrated smoke. That’s smoking. It should be noticed immediately the incredible difference between smoking and simply being exposed to ETS which cannot be equated in any way with smokING. There is no active and passive smoking. There is only smoking which involves inhaling a packet of concentrated smoke. That’s what produces the relatively much higher cotinine reading for smokers that nonsmokers simply simply exposed to ETS.

For those not prepared to test the hypothesis, it should dawn that if smoking was simply being exposed to SHS, then why don’t smokers just leave their cigarette lit in an ashtray and breathe the ambient air? No. They actually take a drag on the cigarette – a packet of concentrated smoke – and inhale. That’s smokING.

For gullible nonsmokers, when you are sitting by an open fire, do you believe you’re “smoking” then? If you’re close-by to lit candles, do you believe you’re “smoking” then? If you’re close to cooking or BBQ smoke, are you “smoking” then? Etc. See the point?

The only term that has a modicum of meaning with little/no application is “involuntary smoking”. This would refer to the situation where a person is forced (e.g., at gunpoint) to take a drag on a cigarette and inhale the packet of concentrated smoke.

Referring to SHS exposure as a “fraction” or a “degree” of smoking for statistical/causal extrapolation has no meaning. SHS exposure and smoking are two entirely different phenomena. Whatever the exposure to SHS, it is not inhaled as in smokING.

This clarification is important because the idea of secondhand “smoking” is still being pushed. For example, consider Bill Gates’ latest antismoking venture:

Focusing on the harmful effects of exposure to others’ smoke, the initiative will aim to help smokers quit and encourage nonsmokers to ask people not to smoke around them. At a news briefing the two billionaires donned green T-shirts reading “Say no to forced smoking” in Chinese. The Microsoft founder won a burst of applause by slowly reciting the slogan, repeating the words after Mr. Li, who is chief executive of the Chinese online search company.

Not only is the inflammatory myth of “forced smoking” perverse, but so too is how one (or a few) billionaire can enter a foreign land and toss their money/deranged beliefs about in order to alter its socio/cultural/economic structure. Gates and Bloomberg have recently also ploughed over $300million into third-world countries (e.g., Africa) for anti-tobacco measures.

JohnB said...

Another antismoking delusion.
Here’s a comment appearing in an Australian newspaper in 1912:
A paragraph in The Register of September 14, 1912, announced that the City Council is daring to deal with the smoke nuisance. If the council can remove from our streets the smoke which is continually puffed in our faces, and so give us a chance to breathe the purest air obtainable, some of us will be exceedingly grateful, and the names of the men responsible for the change will be passed onto future generations as those of men who had courage to face an evil and deal with it and not merely to talk and write on health matters. At present it is dangerous to a person's health to walk through the streets of Adelaide.

Then there’s:
“The right of each person to breathe and enjoy fresh and pure air—air uncontaminated by unhealthful or disagreeable odors and fumes is a constitutional right, and cannot be taken away by legislatures or courts, much less by individuals pursuing their own thoughtless or selfish indulgence.”

Sound familiar? Well, that’s from 1911…..

1911: Dr. Charles Pease stated the position of the Non-Smokers’ Protective League of America in a letter to the New York Times, dated November 10, 1911:

“Clean air” or “pure air” is another antismoker delusion. Air, generally, contains a multitude of chemicals (most of the chemicals in tobacco smoke are already in the air generally, plus more), gases, particulates, bacteria, viruses, pollen, dust, manure dust, animal dander, dead skin scales.

And then along comes the antismoker: “I am an antismoker. Don’t you know that I am a superior being? I own the air…. all of it. I get to decide what is put in and not put in the air. I hate tobacco smoke. Tobacco smoke, or any remnants thereof, must never enter my breathing sphere or any area that I might ever or never frequent. I, your antismoking highness, so decrees.”

Chemicals in air:
Here is a list of 33 of the 188 toxic pollutants the EPA has found will be in clean, cigarette smoke free, air.

Some you may recognize as being in cigarette smoke and there are some that are not found in cigarette smoke.

Acetaldehyde-Acrolein-Acrylonitrile-Arsenic Compounds-Benzene-Beryllium Compounds-1,3-Butadiene-Cadmium Compounds-Carbon tetrachloride-Chloroform-Chromium Compounds-Coke Oven Emissions- 1,3-Dichloropropene-Diesel Particulate Matter-Ethylene dibromide-Ethylene dichloride-Ethylene oxide-Formaldehyde-Hexachlorobenzene- Hydrazine-Lead Compounds-Manganese Compounds-Mercury Compounds-Methylene chloride-Nickel Compounds-Perchloroethylene-Polychlorinated biphenyls (PCB)-Polycyclic Organic Matter (POM)-Polycyclic Aromatic Hydrocarbons (7-PAH)-Propylene dichloride-Quinoline-1,1,2,2-Tetrachloroethane- Trichloroethylene-Vinyl chloride

JohnB said...

Even our exhaled breath contains chemicals:

"Human Exhaled Air Analytics..." Buszewski et al, Biomed. Chromatogr. 21: 553–566 (2007)

The only issue is whether the quantities of chemicals in air are considered safe, i.e., dosimetry. In most cases, unless you’re nearby an erupting volcano or a forest fire, for example, exposure is within permissible exposure limits. The American federal agency governing indoor air quality – Occupational Safety & Health Administration (OSHA) – considers typically encountered smoke (including tobacco) to be within permissible exposure limits for particular constituents. And that’s indoors!

Antismokers have some serious psychological issues projected onto smoke. They believe that air minus tobacco smoke is “pure/clean” and that when tobacco smoke is added, air suddenly becomes “harmful”. Antismokers have no grasp of basic chemistry and the idea of dosimetry is entirely alien to them. Whatever antismokers have made of tobacco smoke, it’s dysfunctional, incoherent.

FXR said...

I posted this on Michael Siegel's blog it is relevant to the current discussion and the study itself with no doubt, will be one of Glanz's future endeavors so in defense ahead of time...

Tommy put forward his cherry farm prize, to discredit the inclusion of ST in the category of harm reduction. In review of the study and the relative timeline, the study would seem to discredit either vaping or ST as reduced risk, rather the opposite was observed.

With slides that show the effects of cancer inductive enzymes P4502A13 and cancer growth. If smoking had the same effect by the biological process, in the same time-frame demonstrated in the study, we would see cancers emerge within days of the first cigarette smoked. It does not happen in the vast majority, of the less than 1% of smokers, that do suffer lung cancer for 50 years. If ST sees cancers [even rarely] in the shorter timeline. One can only expect that vapers will see the same outcome, in far less than 50 years. But only if we can trust the sciences with so much political interference in the way.

Repeated from the last thread;

"Vaping exposes the user to the same mutagenic enzyme initiating nitrosomines and histamines as you find in smokeless tobacco, in spite of your denials.

Tobacco specific isn't entirely informative. Because
nicotine is the only ingredient that defines that specificy. In truth they are nicotine specific. The same nicotine you use while vaping. NNK is a derivative of the plant when grown in nitrogen rich soils, while Histamines are added by heat source pollutants, when curing the tobacco with heating oil [winter diesel]. Neither is a product of burning tobacco [pyrolysis], which tremendously reduces the amounts of the nicotine [P4502A13 initiated] NNK content, that is actually inhaled." 1/1000

I can provide links to numerous published studies in the journals once again, if any of this is in dispute. Of course that would be; disputed by anyone more important than Tommy, who will argue that there are two moons, if it serves; to hide his lies, his angry disposition, or his overly abundant ego]

So Michael;

Care to explain the term "ST causes" in your claim, while e-cigs are any different.

Tell me how my assessment herein is wrong? Further how the same observations would not also apply to the so called "medical alternatives" or formally "medicines"

FXR said...

Continued due to space restriction;

Harm reduction???

Levels of Nitrosomines and histamines [PPAH] in the higher volumes seen in all nicotine containing products, were never necessary at the levels they are normally distributed, and can be reduced by 95% or more by selecting lighter tobacco varieties, adjusting PH levels of the soil, not using roots and stems and in the most part by not curing the tobacco with diesel smoke. A method of fortifying beneficial P450 phase 1 and phase 2 enzymes, in those beyond 50 years of age, or anyone who was found to be deficient, would see far more benefit regardless if you smoke, vap, drink coffee, enjoy well done steaks or burned toast, throughout the entire population, than all the social engineering programs one could ever afford to finance. It is almost sickening to hear medical experts repeating the lie that cancer cells are not detected by the body. The evidence in the same study in the expression of abundant keratin, suggests that the efforts of the immune system to smother the cancer, are an indication that the defense system is initiated and doing it's best to battle the cancer. Keratin expression allows us to identify a cancer type and identify the primary cancer site. Which tells me that the cancer is not only detected, it is classified by the body's defenses as well.

That is the rest of the story.

The one story medicine is too biased or self absorbed, to even discuss, on a rational level. People need to look at the empirical evidence, beyond an emotional level or the many stereotypes injected, Realizing the evidence serves proof that both ST and Vaping provide an extremely low risk and that risk could be far less, with very little effort. While even if you include the risk of second hand smoke [which is much less], are all far below that, if assessed by the same standard, of any approved medicine on the shelf you can name.

Rursus said...

I have completely overlooked the "
control homes"...
I have to apologise!

Anja M. said...

//Glantz has made a basic category error.//

Glantz IS a basic error.

Wow, if even Chapman ridicules this nonsense - just wow!

Look like their prized "unity in public health" is falling apart. *grins* And not a moment too soon, I would say....

Stewart Cowan said...

JohnB quoted,

At a news briefing the two billionaires donned green T-shirts reading “Say no to forced smoking” in Chinese. The Microsoft founder won a burst of applause by slowly reciting the slogan, repeating the words after Mr. Li, who is chief executive of the Chinese online search company.

The eugenicist would be better complaining about China's forced abortions, where women are kidnapped by the state, even in the ninth month of pregnancy, and their babies murdered - and other evils, like the killing-to-order for body parts and Christians abducted and beaten for attending 'unauthorised' churches.

But Gates seems to hate humanity - not just smokers. He has even admitted that his vaccination programme in Africa will lead to smaller populations, which is his reason for funding 'family planning' also in Africa. He also supports Monsanto and the GMO industry, the failings and expense of which have been a contributory factor in the suicides of quarter of a million Indian farmers who were suckered into the con. Gates is the reason I switched to Linux.

The author of this article states,

...Bill Gates might be one of the world's most destructive do-gooders.

Jonathan Bagley said...

Passive smoking for 4 hours a day in a smoky bar has been measured at the equivalent of 10 cigs a year, 730 times less than smoking 20 a day.

"Why did they use geometric mean instead of arithmetic mean as their measure of central tendency?"

Interesting question Carl. I'll try and find out.

Junican said...

Doesn't the geometric mean' have something to do with 'squaring, adding then taking the square root of'? Eg:

8 x 8 = 64.
6 x 6 = 36.
.......100 = 10 x 10.

Carl Darby said...

The geometric mean is the nth root of the product of n numbers. It is <= the arithmetic mean and is usually used to average rates of change. Small values pull the geometric mean down relative to the arithmetic mean. For example the data values 4, 4, and 1 have an arithmetic mean of 3, but a geometric mean of 2.52.

I have a feeling that for the data in this study, the geometric mean of cotinine levels for second-hand smoke and second-hand vapor were closer together than the arithmetic means, so geometric mean was used to make their conclusion stronger.

This is a minor point compared to the fact already pointed out that cotinine from exposure to second-hand vapor does not serve as a proxy for exposure to the chemicals in tobacco smoke. Its just another chance to say "Oh boy, right again." to myself if I ever get a chance to see their data.