A Letter To Costa Constantinides From Dr. Konstantinos Farsalinos, M.D.

Below is an email sent from Dr. Konstantinos Farsalinos, M.D. to Costa Constantinides.
Dr. Farsalinos is a researcher active in the Onassis Cardiac Surgery Center, Athens
reece ! "niversity #os$ital atuis%erg, &euven, Belgium ! and the De$artment of
'harmacology, "niversity of 'atras, reece. Dr. Farsalinos has done e(tensive
research on electronic cigarettes and has $u%lished several $eer reviewed studies.
Costa Constantinides is a mem%er of the )ew *or+ City Council re$resenting District ,,
in -ueens. Mr. Constantinides introduced legislation to the )*C Council that would %an
the sale all flavored e!li.uid in )ew *or+ City.
#ere is how you can ta+e action against this misguided legislation.
from/ Konstantinos Farsalinos 0+farsalinos1gmail.com2
to/ Costa Constantinides 0costa1council.nyc.gov2
date/ 3ed, Oct 4, ,567 at 8/88 'M
su%9ect/ Ban of flavored electronic cigarette li.uids
Dear Mr Constantinides,
: too+ the initiative of contacting you after reading articles in internet newsmedia a%out
your $ro$osal to im$lement a %an on flavored electronic cigarette li.uids.
Such $ro$osals are usually associated with a significant level of misinformation a%out
electronic cigarettes and $atterns of use, as well as a misunderstanding of scientific
findings. : understand that the news media ;and several scientists too< have created a
lot of confusion to the $u%lic and the regulators concerning electronic cigarettes.
: am sending this letter as a scientist, %eing actively involved in electronic cigarette
research ;la%oratory, clinical and $o$ulation studies< as $rinci$le investigator and
research coordinator. : am currently the ,nd most $roductive researcher worldwide in
terms of $u%lications on electronic cigarettes ;$lease see/ 3orldwide research
$roductivity in the field of electronic cigarette/ a %i%liometric analysis<.
: had the $riviledge of $erforming the only study evaluating the im$act of flavor
varia%ility in electronic cigarette e($erience among dedicated electronic cigarette users
;$lease see the full te(t at the "S )ational &i%rary of Medicine<. =he study analy>ed the
res$onses of 7?64 electronic cigarette users, half of whom were from the "S. =he
results of the study confirm that flavors are mar+eted to satisfy demand %y dedicated
va$ers ;all of whom were adult smo+ers or former smo+ers<, and not to attract
youngsters. =he main findings of the study were/

6. =he most $o$ular flavor ty$es were fruit ;?@.7A<, followed %y sweet ;?6.7A< and
to%acco ;7B.@A< flavors.
,. On average, electronic cigarette consumers used B different ty$es of flavors on a
regular %asis. Of note, the num%er of flavors used was inde$endently associated with
com$lete su%stitution of smo+ing with electronic cigarette use.
B. =o%acco flavors were the most $o$ular at initiation of electronic cigarette use, %ut
there was a su%se.uent switch to other ty$es of flavors.
7. =he ma9ority of $artici$ants ;?4.BA< switched %etween flavors daily or within the
same day.
8. More than half of $artici$ants re$orted that the reason for using different flavors
is a $henomenon of taste ;or smell< rece$tor tolerance from using the same flavor for
long!term.
?. Almost half of $artici$ants re$orted that if flavors varia%ility was limited it would
increase their craving for cigarettes, while B@.CA mentioned that it would %e more
difficult for them to .uit smo+ing or reduce cigarette consum$tion.

=his is the only scientific evidence that e(ists a%out flavors and electronic cigarette use,
and shows that flavors $lay an im$ortant role in switching from to%acco to electronic
cigarette use and in $reventing rela$se to smo+ing. =here is also a lot of literature a%out
the $hysiologic effects of flavors on human $erce$tion, and how this affects mood and
sense of well!%eing. =hese are a$$lica%le to adults too, not only to youngsters.
=herefore, it is .uestiona%le why the issue of flavors has %een focused on electronic
cigarettes and many ignore than flavor $erce$tion is a need of adults too.
: understand the legitimate concern a%out attracting youngsters. #owever, it is
.uestiona%le, %oth ethically and legally, whether a grou$ of the society ;smo+ers< should
%e de$rived from the a%ility and the right to choose a significantly less harmful $roduct
%ecause of a legitimate %ut unsu%stantiated ;so far< concern. Moreover, considering the
$o$ulation effect ;which is considered the most im$ortant factor %y the FDA<, the ris+
$osed %y electronic cigarette use is so low that even if a small $ro$ortion of non!
smo+ers ado$ts electronic cigarette use, the ris+s will %e %y far outweighed %y the
%enefits o%served in smo+ers who switch to electronic cigarettes. Of note, none of the
studies so far have evaluated regular use. :n reality, the )*=S survey %y the CDC is
evaluating e($erimentation only ;either ever e($erimenting or e($erimenting within the
$ast B5 days, which is misleadingly characteri>ed as Dcurrent e!cigarette useD<. :n an
analysis that will %e su%mitted for $u%lication in scientific 9ournals shortly, we have
calculated that %y endorsing electronic cigarette use %y smo+ers, an additional
B,555,555 deaths will %e averted in only ,5 years, com$ared to only ?C5,555 deaths
averted with current smo+ing cessation rates. :n my o$inion, this information should %e
seriously considered %y regulators %efore ma+ing any decisions.
As a final note, allow me to comment on a statement attri%uted to you that DThe e-
cigarette industry has openly admitted that they are not in the tobacco cessation
businessE ;htt$/FFo%server.comF,567F65Famerican!va$ing!association!fuming!over!
$ro$osed!%an!on!flavored!e!cigarettesF<. :n reality, it is the law which does not allow
them to state ;or even im$ly< that e!cigarettes should %e used as smo+ing cessation
$roducts. :ronically, they can state that they are to%acco cigarette su%stitutes. =his is
e(actly the same thing as cessations, however it creates confusion and misconce$tion
that the harm from e!cigarette use is e.ual or higher than smo+ing. : thin+ you should %e
concerned a%out how legislation has created such erroneous situations.
: am certain your $ur$ose and goal is to $rotect and to $romote $u%lic health. : +indly
urge you to reconsider your $osition and ma+e any $ro$osals %ased on scientific
evidence and not theoretical or un$roven concerns ;even though they may %e
legitimate<. Smo+ers also deserve to %e $rotected, and %ased on current evidence,
there is no harm to any other $art of the society %y endorsing e!cigarette use as a
to%acco harm reduction strategy and alternative to smo+ing.

3ith res$ect
!!
Thank you
Konstantinos Farsalinos, M.D.
Researcher, Onassis Cardiac Surgery Center, Athens Greece
Researcher, Uniersity !os"ital Gathuis#erg, $euen, %elgiu&
Researcher, De"art&ent o' (har&acology, Uniersity o' (atras, Greece
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