E-cigarettes need quality safeguards
Rapid Response letter published in British Medical
Journal 22 January
public health physician
Health New Zealand Ltd, Christchurch, New Zealand 8082
Flouris and Oikonomou lament the lack of data on e-cigarette
risks. Apart from our 2008 poster cited , our further reports [2,
3] and extensive emissions data we gathered in 2009 show complete
absence of most priority cigarette toxicants in e-cigarette liquid and
mist. However, we only tested one brand (Ruyan,
Beijing). And, as Flouris and Oikonomou point out, quality safeguards in
manufacture are essential.
testing showed all e-brands were less toxic than cigarettes, consumer
safety requires quality control at site of manufacture, and monitoring
to minimise the risk of adulteration. In
1990, propylene glycol, now used to create the mist in e-cigarettes,
was adulterated by toxic diethylene glycol
(DEG) with tragic results. As recently as 2007, US FDA found DEG in
Chinese toothpaste at 3%, and found DEG at 1% level in 2009 in one
e-cigarette brand. E-cigarettes need regulation imposed to safeguard
their quality, so they can continue to provide an alternative to
Murray Laugesen, Public health physician, Health New
Zealand Ltd. www.healthnz.co.nz
1. Flouris AD, Dimitris N Oikonomou DN. Electronic cigarettes: miracle or menace?
Letter. BMJ 2010;340:c311
2. Laugesen M. Safety report on Ruyan
e-cigarette and cartridge. 30 October 2009. http://www.healthnz.co.nz/RuyanCartridgeReport30-Oct-08.pdf
3. Laugesen M. Ruyan
e-cigarette bench-top tests. Poster. Society for Research on Nicotine
and Tobacco. Dublin April 2009. firstname.lastname@example.org/DublinEcigBenchtopHandout.pdf
away Chinese toothpaste, FDA warns. Products may contain poisonous chemical
used in antifreeze. Associated Press 1 June 2007. http://www.msnbc.msn.com/id/18985512/
5. Westenberger BJ. Evaluation of e-cigarettes. Center
for Drug Evaluation and Research, Division of Pharmaceutical Analysis, St Louis, MO. US Food and Drug Administration. 2009.
interests: Research contract with Ruyan
during 2008, but no financial interest in Ruyan.
3 Sunrise programme:
5 July Study suggests rollies worst for health.
Dr Laugesen interviewed re RYOs.
Roll-your-own cigarettes dangerous money-savers:
Jun 26, 2009
By Martin Johnston
NZ Herald http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10580788
smokes could be even more harmful than factory-made cigarettes because
people suck them harder and more efficiently, Christchurch research indicates.
researchers are calling for the Government to act on their findings by
applying a higher tax and specific warnings on roll-your-own tobacco.
the first comparison between the two types of smoking using people rather
than smoking machines, the study suggests rollies
are "apparently no less and possibly more dangerous" than
health specialist Dr Murray Laugesen and his
co-researchers found roll-your-own smokers inhaled 28 per cent more smoke
per filtered cigarette, even though the rollies
contained less tobacco than the factory-mades.
both types boosted the level of carbon monoxide, measured in exhaled
breath, by the same amount.
a smoker of factory-mades lets a lot of the smoke
go up in the air, these roll-your-own smokers suck like crazy and don't let
so much be wasted," Dr Laugesen said
yesterday. "They're getting more value out of the tobacco - and more
study, using cigarette holders containing flow meters, compared 26 people
who usually smoke rollies with 22 who usually
their paper, the researchers said rollies
accounted for nearly a third of tobacco used in New Zealand.
country's comparatively high tobacco excise tax - levied
by tobacco content, not per cigarette - had encouraged smokers to hand-roll
thin cigarettes and pay less tax.
excise increases have perversely encouraged cheaper smoking rather than
research has shown roll-your-own smokers are twice as likely as smokers of
factory-mades to believe rollies
are less risky. Norwegian research shows they also have twice the
lung-cancer risk. Although rollies contain less
tobacco, they contain no fewer additives and their smoke contains much more
Health Minister Tariana Turia
wants more tax on roll-your-own tobacco, but a spokesman for the Finance
Minister said the Government was not considering it.
A study that compared smoking of
roll-your-own and factory-made cigarettes showed rollie
* Inhaled 28 per cent
more smoke per cigarette.
* Took 25 per cent more puffs.
* Puffed for six seconds longer per cigarette.
* Increased their carbon monoxide level by the same amount.
Roll-your-own cigarettes as
dangerous as factory-made cigarettes 18
In research published today, we show that
smokers of RYO cigarettes inhale more smoke and absorb as much carbon
monoxide as factory made cigarette smokers.
LAUGESEN, M., EPTON, M., FRAMPTON, C., GLOVER,
M., LEA, R.A. Hand-rolled cigarette smoking patterns, compared with
factory-made cigarette smoking in New Zealand men. BMC Public Health 2009,
Health warning: Precautions
with e-cigarettes 3 June 2009.
Health New Zealand wishes to warn users of certain dangers due to
defects in the child safety design of some products and brands. See www.healthnz.co.nz/ecigarette.htm
Nicotine pouch to reduce cravings,
(Nicotine snus) now selling in Sweden 19 May 2009
Thornley S, McRobbie H, Lin RB, Bullen C, Hajek P, Laugesen M, Senior H, Whittaker R. A single-blind,
randomized, crossover trial of
the effects of a nicotine pouch on the relief of tobacco withdrawal
and user satisfaction. Nicotine
Tob Res. 2009 Jun;11(6):715-21.
Epub 2009 May 19. Researched at CTRU, Univ of Auckland.
Health New Zealand research presented in Dublin
at the 15th Annual
Conference, Society for Research on Nicotine and Tobacco, (SRNT)
conference, April 2009:
Safety: Ruyan e-cigarette benchtop
tests. Poster 5-11.
www.healthnz.co.nz/DublinEcigBenchtopHandout.pdf The poster itself is found in the
following two powerpoint files: http://www.healthnz.co.nz/DublinEcigPoster1.ppt
The mist of the
e-cigarette has been rigorously tested. Of over 50 priority-listed
cigarette smoke toxicants tested, none was detectable in the mist of the Ruyan® e-cigarette, except for a trace of mercury close
to the limit of detection. Some toxicants remain to be tested before the
results are submitted for publication.
On the basis of findings to date, inhaling mist from the e-cigarette
is rated several orders of magnitude (100 to 1000 times) less dangerous
than smoking tobacco cigarettes. The nicotine dose per puff is comparable
to that of a medicinal nicotine inhaler. E-cigarette nicotine is apparently
not absorbed from the lung, but from the upper airways.
Comment: Given that continued smoking of cigarettes
carries a cumulative 1 in 2 death risk, the findings, argue for
stringent regulation for very low-risk non-medicinal nicotine cigarette
2) the sale of this brand as a non-medicinal cigarette substitute, as
its emissions have been tested.
Status: June 2009: to be
submitted for publication in a peer-reviewed journal.
2) E-cigarette efficacy: Effect of an E-cigarette on
Cravings and Withdrawal, Acceptability and Nicotine Delivery: Randomised Cross-over Trial. Poster 5-50,
On behalf of Ruyan, manufacturer of the Ruyan V8 e-cigarette, Health New Zealand Ltd sponsored this
research carried out in Auckland by researchers at
the School of Population Health, University of Auckland. See
Status May 2009:
The study has been submitted for publication in a peer-reviewed
3) Potential toxicity of
Hand-rolled and Factory-made cigarette smoking compared
Poster 3-41, http://www.healthnz.co.nz/LandscapeTemplRYO_w5graphs.ppt
Status: 5 June 2009 Accepted for publication in BMC
Public Health. See above.
E-cigarettes – a high
tech way to kick the habit? New Scientist
14 February 2009
Thomson interviews Dr Laugesen and WHO. www.NewScientist.com For a clear diagram see:
Safety report on the Ruyan®
e-cigarette & cartridge
30 October 2008
This report (23 pp)
amends and replaces the 21 October report and completes the tests on mist
cartridges meantime. Further test results at pages 9 -11
previous findings, that nothing of note has been found
Safety report on the Ruyan®
e-cigarette & cartridge
21 October 2008
Health New Zealand today released further safety data (22 pages)
based on reports from
laboratories examining various possible safety issues with respect to the
Ruyan® e-cigarette and nicotine cartridge.
Tests are continuing.
Nothing of note has been found so far. This work is funded by Ruyan.
Comparison of toxicity of
RYO and factory-made cigarettes
21 October 2008
Data from 48 smokers have been analysed
and will be presented at the Dublin SRNT conference April 2009. www.srnt.org A paper is being submitted
for publication in a scientific journal. This study was funded by the
Health Sponsorship Council.
withdrawn from sale
23 June 2008
millions in its research, Philip Morris has withdrawn this state-of-the-art
from sale in its test markets in the United States. On a small Heart Foundation grant, Health New
Zealand researched the toxicity of Marlboro UltraSmooth in 2006 (see www.tobaccocontrol.com
and search under Laugesen or Fowles) and found it behaved like a low nicotine
cigarette – fooling
the smoke machine ratings and registering very low
harmful gas emissions. But after adjustment for its
low nicotine, this
cigarette was potentially more toxic than regular Marlboro, more so than Holiday
regular, NZ’s most
popular brand, and more so than 16 regular brands from British Columbia.
Safety of the Ruyan®
1 March 2008, updated 9 April
See Health New Zealand’s poster How safe is the e-cigarette? presented to the 14th
of the Society for
Research on Nicotine and Tobacco (SRNT) in Portland, Oregon, USA, 1 March
2008, which attracted
considerable interest. http://www.healthnz.co.nz/Portland2008ECIG.pdf
Since April 2008 this website has attracted over 20 hits per
Further tests are
planned for the Ruyan® e-cigarette.
Fast acting nicotine pouch, mouth spray and lozenge
– NEWS Study
1 March 2008
See the final report http://www.healthnz.co.nz/NicoNovumSRNT2008Poster.pdf
presented at the
meeting, Portland, Oregon, 2008. The study
is to be published in Nicotine & Tobacco
Research (first author
Dr Simon Thornley).
The pouch and mouth
spray were clinically effective and may give faster and greater relief of
gum. In 2007, nearly 80 smokers completed a phase three trial of three fast
nicotine products in
the NEWS study (Niconovum Evaluation of
Withdrawal relief study) at
Research Unit, School of Population Health, University of Auckland. Dr Hayden
McRobbie was the
principal investigator, and Dr Laugesen of Health
New Zealand, a co-investigator.
This was sponsored by
Heart Foundation, and Niconovum AB, Sweden.
First cigarettes can
13 December 2007
Scragg R, Wellman R, Laugesen
M. DiFranza J. ‘Diminished Autonomy over
Appear With the First
Cigarettes’ Addictive Behaviours 2008. Doi:10.1016/j.addbeh.2007.12.002
Abstract at www.pubmed.org (search under author)
Full text at http://www.healthnz.co.nz/Addiction1stcigFeb08.pdf
This study, written up
by two New
Zealand and two US researchers, analyses results from the
ASH New Zealand surveys of smoking in year 10 students. The
ASH survey included the
Hooked On Nicotine Checklist (HONC) of DiFranza et al,
of symptoms of students’ loss of
autonomy (control) over their smoking. Dr Laugesen included this checklist in the ASH surveys
of 2002-2004, answered by nearly 100,000
students, and Dr Robert Scragg analysed the data.
Our data confirm
previous reports that diminished autonomy appears soon after the onset of
intermittent tobacco use. We extend this literature by
providing the first description of how
diminished autonomy develops in relation to the total
number of cigarettes smoked.
Our data indicate that the first cigarette can
prompt a loss of autonomy in one in four
A2 Milk to be sold throughout
NZ, including South Island
The Press, Christchurch NZ. 12 Dec 07 www.press.co.nz
Ridge Natural Foods
has arranged to supply 150 Countdown supermarkets including
with A1 beta-casein -free milk for a retail price of $4.50 per 2L,
as opposed to $3.50 for A1-containing milk. www.healthnz.co.nz/milk.htm
This fulfils one of
the aims of Health New Zealand’s research on A1 milk in 2003; to
ensure choice for
consumers wishing to apply the precautionary principle to their own
milk purchases. Eventually A2 milk could fetch a
premium at the farm gate, persuading
dairy farmers to use only bull semen of pure A2
No smoke No fire Just
nicotine. NZ Herald. 8 December 2007
(the Ruyan® e-cigarette) www.smokeless.org.nz/NosmokeNofire.htm
Health New Zealand milk research in the news again 30 Oct 07
Health New Zealand research on A1 milk is being
quoted at length in a recent book.
Health New Zealand Ltd to test the Ruyan®
17 October 2007
SBT Holdings Ltd
(Hong Kong and Beijing), recently renamed Ruyan® Holdings Ltd, a subsidiary of Golden
Dragon Holdings Ltd, Hong Kong,
has selected Health New Zealand Ltd to test the Ruyan®
e-cigarette, a promising cigarette-substitute device that rapidly
delivers nicotine to the lungs, without the tar and other harmful smoke
gases, for its first full testing outside of China. Subject to the
necessary approvals, Health New Zealand Ltd will be testing its effect in
raising nicotine blood levels and in satisfying the smokers’ need
for another cigarette. For more on the e-cigarette, see www.healthnz.co.nz/ecigarette.htm and for more still see www.healthnz.co.nz/Ruyan®
R-rated film viewing and adolescent smoking
– classification does matter
24 August, 2007
Murray Laugesen, Robert Scragg,
Robert Wellman, Joseph DiFranza.
Medicine 2007 doi:10.1016/j.ypmed.2007.07.025
ASH surveyed nearly
100,000 Year 10 students in 2002-4, and found 94% of students watched
R-rated movies, nearly
80% watched them at least monthly, and 38.5% watched them weekly.
Weekly viewing of
R-rated movies nearly tripled students’ susceptibility to future
was linked to a
doubling of past experimentation and of current smoking, compared to those
watching R-rated films at all.
We conclude that
classifying all smoky G and PG films as R-rated will usefully protect some
not all young people from viewing on-screen
smoking. The findings apply to all ethnic groups, and
remain after allowing for smoking by family and best
Heart Foundation declines to fund research of snuff as alternative
3 August 2007
Funding of the
testing of the best available stop-smoking aids should be a shoe-in. Not
so. Health New Zealand applied
31 March to the National Heart Foundation for research funds for SNEWS
(Snuff and Nicotine Evaluation of Withdrawal relief Study) to compare
nasal and oral snuff with a fast acting nicotine pouch and nicotine gum.
The NHF grant round was sufficiently funded to cover one-third of
applications. Health New
Zealand was not successful.
Because snuff is tobacco and addictive, many of those who believe in
tobacco abstinence as the national goal, are not enthusiastic for
researching it. Others such as
Health New Zealand Ltd, believe smoking is the
problem, and seek to test a range of scientifically-based cigarette
substitute products. The research design was based on the successful NEWS
study (see above).
This is the third of
three applications for funding of trials of snuff in New
Zealand to be rejected by health
funding bodies. Industry funding is available, but whether they sell
nicotine or tobacco, each company is usually only interested in
researching its own product, providing no useful comparison. Apart from
this, researchers know tobacco industry funding these days can damage
their future careers.
included principal investigator Dr Murray Laugesen,
biostatistician Dr Chris Frampton, addiction specialist, Professor Doug Sellman, respiratory physician Dr Mark Epton, and smoking cessation experts Dr Mark
Wallace-Bell and Trish Fraser. This research was to investigate a short
list of available nicotine-containing products most likely to quell
smokers’ urges to smoke. This was an open-label cross-over trial,
in which some 50 addicted smokers were to each try a different product
each morning in random sequence to test the ability of each to relieve
their urge to smoke. See http://www.healthnz.co.nz/VASurges.htm
of smoking of family and best friend on adolescent smoking. July 2007.
Robert Scragg and Murray Laugesen.
and New Zealand Journal of Public Health.2007; 31:
Based on the ASH survey of year 10 students in 2002, we show family smoking
is highly influential, even
when the influence of best
friend is allowed for. www.healthnz.co.nz/ANZJPH
2007-3 pp 217-223 Scragg.pdf
Sponsorship Council funds hand-rolled cigarette toxicity study
31 May 2007
Health Sponsorship Council has granted funding for Health New Zealand to test the
first stage of a study
to test the toxicity of
hand-rolled cigarettes compared with factory-made cigarettes. Eighty
European and Maori smokers, will help determine how intensively each
type of cigarette is smoked, and
based on these measurements,
the average levels of smoke toxicants from each type of cigarette.
Health New Zealand shifts to Lyttelton, Christchurch in 2006
From 1 September 2006,
after nearly ten years in the Auckland
region, Health New Zealand Ltd shifted to Christchurch.
With the help of broadband, and Skype for low
cost tolls, we plan to keep in contact as before.
Nicotine and Tobacco Research Conference in Europe and lecture at
Dr Laugesen attended the Fourth conference of
the Society for Research on Nicotine and Tobacco in Kusadasi
23-26 September 2006, and in early October lectured on Snuffing out cigarette sales in New Zealand to the Tobacco Working Group at
the Harvard School of Public Health, Cambridge
Zealand research published in Tobacco
The first independent report
assessing the toxicity of the Marlboro UltraSmooth
cigarette brand, which Philip Morris was test marketing in the USA
during 2005, by Drs Laugesen (Health New Zealand Ltd) and Fowles (ESR) was published in Tobacco Control journal in December 2006. See www.healthnz.co.nz/MUS.htm
Laugesen M and Fowles J. Marlboro UltraSmooth
- a potentially reduced exposure cigarette? Tobacco Control December
The smoke of Marlboro UltraSmooth
was tested against smoke from Marlboro Red Regular and Holiday
regular brands, and compared with smoke results from 16 Canadian regular
brands. A grant from the NZ Heart Foundation of $15,000 paid for the
laboratory testing in Canada.
Current research 2006-9
Health New Zealand
is working to provide smokers with better nicotine products to help them
quit smoking. In 2005, Health Research Council of NZ awarded grants for
three randomized controlled trials of smoking cessation methods to the Clinical
Trials Research Unit (CTRU), School
of Population Health, University of Auckland.
Dr Laugesen is a co-investigator for these major research projects. The
first (the PICNIC study, using NRT before quit date) completed
recruitment of over 1000 volunteers by May 2007, and the second (the
SONIQ study letting quitters choose from a selection of nicotine
products) begins late 2007. The third, beginning 2008 tests usefulness of
reduced nicotine cigarettes along with nicotine products during quitting.
Tobacco policy presentation
powerpoint presentation of 24 March 2006 at the University
of Auckland symposium Towards a Smokeless New Zealand. www.healthnz.co.nz/StubbingOutCigaretteSales.htm
called for an end to cigarette sales within ten years, making use of
smokeless nicotine and/or tobacco alternatives for addicted smokers.
(Repeat clicking will gain access to the file).
A new charitable trust, SmokeLess New Zealand
Inc, www.smokeless.org.nz has
since been formed to help end cigarette sales, and has been active in the
media since that time.
Physicians alerted to harm reduction
May 2005 marked the release of the Royal
of Physicians report on Tobacco
Policy – using evidence for better outcomes. Dr Laugesen was a
member of the College’s working party.
One of the aims of business is to stay in
business. July 2005 marked the 10th anniversary of the
founding of the company. For Dr Laugesen, 2005 also marked 21 years of
work in reducing smoking in New Zealand.
address See www.healthnz.co.nz/Lyttelton.htm