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8 recent analysis shows nicotine toxicity is perhaps 20 times lower than widely assumed 21. Although calls to US poisons centres are rising in line with growth and public awareness of e-cigarettes and liquids, they represent a tiny fraction of the calls arising from medicines, cosmetics, domestic cleaning products etc 22 23. There is a simple protective measure available: to insist on child resistant packaging, for which there is an ISO standard 24. 3.1.3 Ultrafine particles Some have claimed that the aerosol droplets in e-cigarette vapour have a similar effect on the body as the particles in tobacco smoke or diesel exhaust 25. This makes little sense as the chemistry of the vapour particle is completely different, and it is the toxicity of the particles that causes damage with tobacco smoke and environmental pollution – the entire argument is baseless 26. 3.1.4 Formaldehyde A news story originating in Japan suggested that e-cigarette vapour could contain up to ten times as much formaldehyde as conventional cigarette smoke. This was in fact an anomalous single unpublished and unverifiable result, almost certainly arising from the device running hot and dry. Looking more carefully at the published results, the overall picture showed formaldehyde levels 6-50 times lower than for cigarettes 27. The mistake was repeated in a letter in the New England Journal of Medicine 28 claiming that formaldehyde-related cancer risks from e-cigarettes were 5-15 times higher than for cigarettes, but the experiment made the elementary error of running the vaporiser in ‘dry puff’ conditions that no human user would ever be exposed to 29. Under normal operating conditions, no formaldehyde was detected. Cigarettes contain thousands of chemicals not present in e- cigarettes and formaldehyde is widely present in the environment. 3.1.5 Carcinogens and toxicants Carcinogens are found almost everywhere. For example writing in 1998, one of the leaders in the field said 30: “Over 1000 chemicals have been described in coffee: 27 have been tested and 19 are rodent carcinogens. Plants that we eat contain thousands of natural pesticides, which protect plants from insects and other predators: 64 have been tested and 35 are rodent carcinogens”. The question is whether any carcinogens cause exposures at levels and via pathways that pose a material 21 Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self- experiments in the nineteenth century. Arch Toxicol 2014; 88: 5–7. [link] 22 2013 Annual Report of the American Association of Poison Control Centers ’ National Poison Data System (NPDS). Calls for e-cigarettes and nicotine liquids were 1,543 in 2013 and 3,957 in 2014, respectively just 0.06% and 0.15% of the total exposure calls. Table 17A shows calls for analgesics (298,633), cosmetics (199,838), cleaning substances (196,183) etc. [link] 23 Full discussion of the evidence at Bates C. Keep calm it’s only poison, The Counterfactual. 17 November 2014 [link] 24 ISO 8317 Child resistant packaging [link][guide] 25 See for example, WHO paper for FCTC COP-6, Electronic nicotine Delivery Systems, 1 September 2014. Para 15-16 [link] 26 Full discussion of the evidence at Bates C. Scientific sleight of hand: constructing concern about ‘particulates’ from e- cigarettes, The Counterfactual. 17 November 2014 [link] 27 Farsalinos K. Electronic cigarette aerosol contains 6 times LESS formaldehyde than tobacco cigarette smoke. 27 November 2014. [Link] 28 Jensen RP, Luo W, Pankow JF, Strongin RM, Peyton DH. Hidden formaldehyde in e-cigarette aerosols. N Engl J Med 2015; 372: 392–4. [link] 29 See full detailed critique at Counterfactual, Spreading fear and confusion with misleading formaldehyde studies, 21 January 2015, with links to detailed assessments [link]. 30 Ames BN, Gold LS. The prevention of cancer. Drug Metab Rev 1998; 30: 201–23.[link]