Here, they find a correlation between e-cigarette use and higher and more sustained levels of smoking. But because this is a cross-sectional study, they cannot determine which came first. In other words, what is the direction of the causal relationship? Does the e-cigarette use precede, and cause, the smoking? Or does the smoking precede, and cause, the e-cigarette use?

Before anyone swears off electronic cigarettes completely (which is not the point of this article by the way) the levels of diacetyl and acetyl propionyl present are higher than the NIOSH standards, BUT they are severely lower than that of regular cigarettes. In terms of getting obliterative bronchiolitis, it is still a lot safer to use electronic cigarettes over regular cigarettes as the diacetyl and acetyl propionyl are much lower, but just because they are lower, we cannot dismiss diacetyl being in our E-Juices immediately. If they flavors do have diacetyl, they should be avoided if possible. In fact, TFA/TPA is coming out with a new line of custard and cream flavors (known as the V2) that contain little to no diacetyl in their flavorings. I am hesitant to believe there aren’t at least traces of diacetyl present as we already know even some fruit flavors have them. But hopefully it will meet the NIOSH standards with their new line. With TFA/TPA spearheading non-diacetyl rich flavorings, it is my hope that other flavoring companies are following the same practice. Electronic cigarettes are becoming increasingly popular every day; the flavoring companies need to meet the demands of the community and avoid diacetyl in their flavorings if possible.

In his on the Hit & Run blog, Jacob Sullum nicely points out the way in which Dr. Frieden is completely ignoring the multitude of data showing that literally thousands of ex-smokers were able to quit smoking using electronic cigarettes. He continues to call these people nothing but "anecdotes." Sullum also points out that Dr. Frieden is " from whole cloth in an effort to portray theproduct as a grave threat to public health and a menace to 'ourchildren.'"

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