Absurdly high nicotine strengths. Incorrectly set devices and apparent ignorance of how e-cigarettes work. The latest study on the risks of e-cigarettes from Danderyd Hospital has been heavily criticized.
"Given that the researchers clearly do not understand how to use an e-cigarette, the inputs are likely to be contaminated with smoke and other toxic substances not normally found in a vejp. It is fortunate that no one was harmed when they conducted their tests" says Karl-Åke Johansson, vejp user, former product developer and spokesperson for NNA Sweden.
"Smoking e-cigarettes is as dangerous as smoking regular cigarettes"
The headlines in the newspapers since doctor Magnus Lundbäck published his latest study on how nicotine i from e-cigarettes affect blood vessels, did not sway on the target.
"Nicotine is more dangerous than we previously thought. We need to ban flavors in e-cigarettes to protect our young people" wrote Magnus Lundbäck, together with two like-minded researchers, in a debate article in Göteborgs Posten just a few days after the report was published at Danderyd Hospital.
"Terrified of e-cigarettes and white snus"
Karl-Åke Johansson, an IT technician by day, but also spokesperson for the consumer association New Nicotine Alliance Sweden, says he's not very confident. This is not the first time that researchers, with support from the Swedish Heart-Lung Foundation and the Swedish Cancer Society, have made headlines with "new findings" about the "unknown risks" of e-cigarettes. And it won't be the last either, he says.
"They are terrified of vejpning and nicotine pouches. If the proportion of smokers in Sweden falls below 5% and Sweden is considered an official smoke-free country by the WHO, they will lose their raison d'être. They will do anything to keep the millions of dollars they receive annually from the government to run their businesses. Many people's careers are financed by that money. They don't want a quick end to smoking, but preferably a long and drawn-out one," he tells Vejpkollen as we go through the latest report from Danderyd Hospital.
Strong lobby against e-cigarettes
E-cigarettes are controversial products that have sparked debate since they were introduced to the market over 20 years ago. Within a few years, the traditional tobacco control apparatus had already started to creak at the seams. The rhetoric: this was probably just another ploy by the tobacco industry to fool nicotine users that 'smoking is not that bad'. It wasn't long before calls for bans and restrictions on flavorings started to appear in the lobby channels. Campaigners ranged from pharmaceutical companies to traditional anti-tobacco activists.
Reducing risks "by magnitudes"
It soon became clear that vejpning, i.e. vaporizing a glycerine liquid with nicotine, was indeed something completely different from smoking. The steam, produced at a temperature of around 250 degrees, does not consist of a variety of toxins and soot particles produced by combustion. Instead, it consists of water-soluble glycerine droplets mixed with air, a substance that leaves no residual trace in the lungs. The scientific understanding of vejpning has grown dramatically in the 20 years that the products have been on the market and according to the most comprehensive meta-analytical studies funded by British Public Health Agency vejping "in terms of magnitudes" poses significantly lower risks than smoking cigarettes.
"It's actually common sense. The key point is that the temperature required to vaporize e-liquid is significantly lower than that required to burn tobacco. At 1000 degrees, the temperature of the embers at the top of a cigarette, tobacco turns to soot and ash as the material degrades. This also produces thousands of toxins, most of which are carcinogenic or directly harmful to cells and blood vessels. E-liquid and the wick material in an e-cigarette never have time to degrade to the same extent. Already at 300 degrees it starts to get too hot. If the e-juice or wicking material overheats, it tastes so awful that most people start coughing by reflex. In everyday life, it is a self-regulating system for minimizing damage," says Karl Åke Johansson.
"Had to learn from scratch"
E-cigarettes have looked different over the years, depending on fashion and demand. But the technology has remained the same.
"I started vejpa sometime between 2010 and 2012. I actually don't remember anymore. That's when I stopped smoking, anyway. Back then, the supply was very limited. Many of us who vejped then had to learn the technique from scratch. It involved everything from making e-juice to putting together parts of different devices to make it work. Nowadays, things are really different. A mostly positive development, although there is a constant struggle to explain the point of vejpning to everyone from politicians to smokers" says Karl- Åke Johansson.
Varying knowledge about e-cigs
E-cigarettes are now available in their simplest form, disposable models, in almost every shop selling cigarettes and tobacco. At the same time, knowledge of the technology is very patchy, at least outside the growing network of users who help each other quit smoking by switching to e-cigarettes.
"This is particularly noticeable when researchers, such as Magnus Lundbäck and his team in Danderyd, fail to acquire basic knowledge of how an e-cigarette actually works. They have probably never used the products they use in their tests, never bothered to ask anyone who knows, and their subjects have probably not had it so easy," says Karl Åke Johansson to Vejpkollen.
Swedish doctors focus on risks
The high-profile report from Danderyd found that users of e-cigarettes and nicotine-containing e-liquid are at risk of blood vessel and cell damage to the same extent as if they had smoked cigarettes. However, previous research has demonstrated the opposite - clear improvements when smokers switch to nicotine e-cigarettes. The message of the Danderyd research struck a chord in the media, where "e-cigarettes are as dangerous as cigarettes" became the dominant headlines.
"That was the first thing that surprised me. If the overwhelming majority of research to date has found that vejp users have better cardiovascular health - as a natural result of quitting smoking - how can a small Swedish study suddenly come up with something that contradicts the world-leading research?" says Karl-Åke Johansson.
Misaligned appliances in the tests
However, it was only when Karl-Åke Johansson saw the products used by the researchers in Danderyd, and how they used them, that he started drinking coffee.
"I reacted to two things. One is that they used a device that is very powerful. Absolutely no beginner's stuff - it requires a certain technique to work properly. They also write that they used so-called temperature control, a built-in finesse in the machine, to set a certain temperature for the "steam". But then you read that they installed an evaporator that does not work for temperature control. This means that the e-cigarette will use its full power to bring up the temperature that it still thinks is at room temperature. The e-liquid could easily have reached 600 degrees and degraded significantly, which is guaranteed to contaminate the test with a variety of toxic substances other than just nicotine," says Karl-Åke Johansson.
Used nicotine shot - with 19 mg/ml
The other thing that Karl-Åke Johansson reacted to was the actual e-liquid that the researchers used in their tests. According to the report, it was an unflavored e-juice with a nicotine concentration of 19 mg/ml, consisting of equal parts glycerine and propylene glycol.
"It is clear that they used a so-called nicotine shot - a product that is supposed to be mixed to much lower concentrations in a nicotine-free e-liquid. What is striking is that they had the subjects vejpake this highly concentrated liquid at a power as high as 32 watts. This can produce a very powerful vapor, which actually requires a lot of air and cooling via direct lung flares to even work." says Karl-Åke Johansson.
"Unnaturally high nicotine content for that effect"
He also believes that e-juice with such a high nicotine content, which the researchers in Danderyd used, is not intended to be vejpas with higher power than 5-10 watts. This is a common effect in pod systems or disposable models, for example. The device used by the researchers in Danderyd, an Evic Primo (75w) with an associated tank, is therefore not suitable for use with highly concentrated nicotine, says Karl-Åke Johansson. And according to Karl-Åke Johansson, this is something that the researchers should have been aware of.
"A conversation with an employee at one of Sweden's vejp shops would have made that clear. For such high effects, it is usual to use a concentration of 3 to 6 mg/ml - not 19 mg/ml," says Karl-Åke Johansson. "The result was probably a large overdose of nicotine in each puff. In reality, no one had vejpat in that way for a long period.
May have been smoke instead of steam
According to Karl-Åke Johansson, the combination of high nicotine levels and ignorant handling of the devices probably contributed to the fact that the input values from the experiment cannot be trusted. In addition, it could have been bad for the subjects.
"They probably didn't inhale vapor, but a smoke mixture. It was just pure luck that one of the participants did not have a heart problem. Nicotine in such large doses can cause cardiac arrest - it could have ended really badly." says Karl-Åke Johansson.
Research is important - but in the right way
According to Karl-Åke Johansson, the researchers behind the study should be held accountable for their methods. He believes that a study based on incorrect input values should be consigned to the dustbin.
"It is of course very important to study the effects of vejpning. But this study is so poorly done that it is impossible to draw any conclusions. Now I suspect that the purpose and background of the study is just to highlight the risks of nicotine use and vejpning in particular. Had they had a more reasonable methodology, say by using one-off models or similar, the results would probably not have been as hoped. A sign of controlled research, where you have a ready-made message that you then "confirm" with a study. This is a clear warning flag for decision-makers who are likely to be curious about the report," says Karl-Åke Johansson.
Have contacted the researcher in charge
Behind the study from Danderyd is the doctor Magnus Lundbäck, who has also appeared in several media regarding the study. Vejpkollen has sought him for a comment on the criticism and is awaiting a response.
Incredibly unethical to doubt that vejping could be anywhere near as harmful to health as smoking. It's like believing that the risk of accidents would be as high when riding a train at 200 km/h as if you were doing the same on a motorcycle without a helmet in just shorts and a t-shirt.
Someone shared Vejpkollen's post on social media and wrote that the study's claims were "outright wrong". But that's not really true, and neither is what Vejpkollen writes here.
I read here on Vejpkollen, then the study itself, and thought "but wait a minute - does the study even DO what social media is accusing it of?"
The study was to investigate how 30 puffs of EC aerosol affected the coagulation and microcirculation of healthy volunteers. They compared before and after inhalation. Results: It had a negative effect.
They write EC aerosol throughout - not e-cigarette, 1TP8 vapor or other. Nowhere in the study's purpose does it say that it sets out to actually find out how "real vejping" itself affects - i.e. not actual e-cigarette smoking with realistic temperatures, doses or puffs. On the contrary, the authors mention under the heading "strengths and limitations" about how the study method does not reflect how to vejp in real life.
The study results themselves are hardly wrong or misleading. It is only when one tries to draw too far-reaching conclusions from the results that it becomes wrong. This is the kind of error that some journalists seem to have made here. But the authors themselves make no claims in the discussion section of the study about what potential health risks of vejpare they would have managed to identify - no, they speculate instead about pharmacodynamics.
What the researchers themselves said in other contexts is not clear,
and Vejpkollen is "awaiting a response" from the study director. But whether or not the researchers and the study deserve criticism, one should at least criticize when OTHERS make too much of a simple experimental study.
Now I still think that the researchers screwed up and that they probably really wanted a more realistic dosage. But then the criticism should be directed at ill-considered methods - not at "false claims" if there are none. And criticism should always be directed at THOSE WHO OVERTELL the study results (journalists, people on social media, other researchers). Vejpkollen can be useful here, clarifying and clearing up misunderstandings.
In conclusion, I think much of the criticism of the study itself is misdirected - criticism should rather be directed at those who draw unsound conclusions from a study that has strong limitations.