Friday, 11 September 2015 17:30

By Dr Farsalinos

Two days ago I presented the case for retraction of the NEJM research letter on formaldehyde release from e-cigarettes, with a series of letters, co-authored with Clive Bates, that were published in Addiction. In brief, they performed a laboratory experiment in completely unrealistic conditions, they overheated the devices completely ignoring the dry puff phenomenon and, of course, they found huge levels of formaldehyde (to be accurate, they did not find any formaldehyde, they only found formaldehyde hemiacetals).

Considering all the reactions to this research letter (including my study on Addiction about aldehyde release in realistic and dry puff conditions, and the letter by 40 academics that the NEJM letter should be retracted), the authors of the NEJM study have been rewarded with a 3.5 million dollars to expand on the NEJM letter by performing more studies (like that one?) on aldehydes release to e-cigarette aerosol.

So, this is a typical example of creating a problem and then getting HUGE funding to further explore the problem and solve it. The questions raised are:

How will they explore the problem? There is a large variability of devices in the market, some with the ability to generate large power levels. We all know that specific power levels can be used by specific equipment, depending on many factors such as wicking material, coil thickness, airflow etc. Are they going to obtain a VW device and test a CE4 atomizer at 20 or 30 W? Are they going to ignore dry puff conditions, which are perceived only by vapers? What will the solution be? I suspect we will see a limitation of power capacity of battery devices. Is this appropriate? Of course not. Some devices will be thrown out of the market. There are atomizers which do not even produce any aerosol at power levels below 15 watts (let alone some drippers with thick coils, which do not even work at 20 or even 30 W). Moreover, forcing vapers to reduce power levels will result in higher puff durations. This will not only make vaping more tiring, but it will also affect aldehydes release, because puff duration is a major determinant of this.

Let me clarify that I have nothing against the Portland researchers, and in fact I congratulate them for getting the funding. However, we must be protected from bad science. The NEJM research letter was bad science. I am concerned that the authors have not yet acknowledged that, and I am not sure if they have really understood the methodological mistakes of their study. Thus, I am not at all convinced that the 3.5 million funding will result in good science and progress on e-cigarette research.

Some people have criticized the Portland funding on social media (mainly twitter), mentioning my name and the number of studies I have published. The cost of all the studies I have performed all the past 3 years (and some more which have not been published yet and come from the latest crowdfunding campaign) was less than 1/15th of what Portland University got now. I can admit that it is tempting to create problems and then get the necessary funding to perform all the studies we have thought of and have already prepared in protocols. Of course, this is not considered a conflict of interest and Lancet will never publish an editorial as they did for the Public Health England Report on e-cigarettes.

Retraction Watch covered the story. Instead of focusing on the main story and the documentation, they added a lot of sauce. Moreover, they asked Prof Peyton for his opinion, and they quoted him saying: “No one seems to be arguing with the science; they just seem very much to want the shading of the interpretation to match certain agendas”. First, I am not only concerned but certain that he Prof Peyton has still not understood the methodological mistakes of the study. Secondly, the pursuit for a 3.5 million grant can be easier considered an agenda rather than our effort to protect the public (especially smokers) from rubbish information like “… make the devices up to 15 times more cancerous than regular cigarettes”. Prof Peyton should have shown some respect to our work. I will remind him that the whole diacetyl and acetyl propionyl issue was raised by our group at a time when scientists were even asking us how we got the idea to make that study. So, I return back the statements about “certain agendas”.

How can we make sure that good science prevails? By performing good science and publish the results. I can now announce that, using the latest crowdfunding funds, I have purchased the same equipment used in the NEJM study (CE4 atomizers and Innokin iTaste VV V3.0 battery) and I have already completed a study on experienced vapers asking them to identify the voltage levels associated with the initiation of dry puffs (all vapers were blinded to the voltage levels). We will soon proceed with measuring aldehydes release in normal and dry puff conditions, using the same equipment and the feedback we got from the vapers. I can reveal that none of the vapers even approached the 5 Volt level that generated huge levels of formaldehyde hemiacetals in the NEJM study. One thing is for sure, we will publish all results, whether good or bad for e-cigarettes. But we are determined not to let anyone publish bad science without receiving the deserved (and evidence-based) criticism.

Considering the story by Portland University and the latest CEH report, it seems that researchers are just buying e-cigarette devices and testing them all under the same conditions, ignoring that each device has different characteristics and, thus, is used differently. In any case, we will not leave them alone promoting the most irresponsible campaign of misinformation and intimidation (it does not matter if it is done deliberately or by ignorance). I am discussing with colleagues, very important and well-known scientists in the field, the possibility to initiate a new crowdfunding campaign, to test as many devices as we can under realistic conditions. We do not need millions, but we are determined to not let bad science prevail without a strong fight back. We will do our best to present as much data as possible, dedicated to performing realistic and relevant experiments in order to provide accurate and reliable information for smokers and vapers to make informed decisions. If we find aldehydes at levels higher than smoking (whether 2 times, 15 times or 1000 times) we will be the first to report it. The “agenda” discussions are not touching us, and we will not enter to this irrelevant discussion which is used only when there is lack of arguments or evidence-based opinion.