Not Making Sense: Health Professionals Giving Misleading Advice About Electronic Cigarettes

It's one thing to give out misleading or misguided advice. It's another thing to do so when you really don't know what you're talking about.

Yet this is exactly what is happening, it appears, with advice from a number of health professionals on the use of electronic cigarettes.

In an article in the New York Daily News (which was prompted by Katherine Heigl's vaping demonstration on the David Letterman show), the medical director of the Cardiac and Pulmonary Wellness and Rehabilitation Program at NYU Langone Medical Center was quoted as urging people not to use electronic cigarettes because: "It’s nicotine, it’s a drug, it’s addictive and it has health consequences." Instead, the physician recommends that people use nicotine replacement products.

Moreover, the physician apparently told the newspaper that: "some of the chemicals in the propellant that helps to vaporize the nicotine are dangerous."

In addition, he apparently stated that electronic cigarettes "are not a good way or an approved way to quit smoking."

Another physician, who is an internist and pulmonary specialist at Lenox Hill Hospital, was quoted as telling the public: "inhaling fumes from the plastic tubes can be carcinogenic."

Also in the article, a respiratory therapist was quoted as stating: "At this point, they are a drug delivery service. It’s a little cigarette that lets you inhale nicotine. And inhalation is the fastest route of drug delivery. I do not recommend them."

The Rest of the Story

Let's take each of these public statements, one at a time:

1. "It’s nicotine, it’s a drug, it’s addictive and it has health consequences."

The very same can be said of each of the following products: nicotine patches, nicotine gum, and nicotine inhalers.

Does that mean that nicotine replacement therapy should not be recommended by physicians? Obviously not. In fact, the same physician who argued against the use of electronic cigarettes because they deliver nicotine recommended the use of nicotine replacement products. Does he not understand that what makes a smoking cessation product effective is that it delivers nicotine? If the product did not deliver nicotine or somehow affect nicotine receptors or the ensuing chemical effects, it would not be effective for smoking cessation.

In other words, the statement is nonsensical.

Nevertheless, it was offered as national advice to a national audience of readers.

2. "Some of the chemicals in the propellant that helps to vaporize the nicotine are dangerous."

Name one.

Other than diethylene glycol, which has been found in only one brand of electronic cigarettes (and which has been confirmed not to be present in all other brands that have been tested in studies available online), I challenge the physician or anyone else making such a statement to name one chemical in the propellant which has been demonstrated to be dangerous to humans at the level at which it is inhaled in electronic cigarette vapor.

There simply is no evidence to support this statement. One could state that the risks are unknown and that a chemical in the propellant might be dangerous, but to state that some of the chemicals are dangerous is unsupported by any scientific evidence, and therefore, irresponsible.

3. Electronic cigarettes "are not a good way ... to quit smoking."

Where is the evidence to support such a statement? I could certainly understand a statement that we don't know whether electronic cigarettes are a good way to quit smoking because there are not scientific studies which have examined the issues. But in the absence of such studies, how can one claim that they are not a good way to quit? How can you know the answer to the question before you have tried to answer it?

There is tremendous anecdotal evidence, from the experience of vapers, that electronic cigarettes are indeed a very effective way of quitting smoking. While it is understandable that one might require more systematic evidence before proclaiming that they are a good way to quit smoking, there is absolutely no evidence that they are a bad way to quit smoking. The statement is unfounded.

4. "Inhaling fumes from the plastic tubes can be carcinogenic."

Where is the evidence that vapers are being exposed to carcinogens from the plastic tubing of electronic cigarettes.

I defy anyone making such a claim to show me the scientific study in which it was shown that vapers are exposed to carcinogens from the plastic tubing.

Until such a study is conducted, the statement is unsupported and irresponsible.

5. "At this point, they are a drug delivery service. It ... lets you inhale nicotine. And inhalation is the fastest route of drug delivery. I do not recommend them."

The very same is true of nicotine inhalers. Does the respiratory therapist also advise people not to use nicotine inhalers?

The rest of the story is that some health professionals are apparently providing uninformed, misinformed, misguided, and/or nonsensical advice to the public regarding electronic cigarettes.

Why is there such a disconnect between actual scientific evidence and advice about electronic cigarettes? I have two hypotheses:

First, I think that many health practitioners have an ideological barrier in place. They simply cannot accept that a behavior that looks like smoking could possibly be recommended, even if it greatly improves people's health.

Second, I think that many health practitioners are influenced, directly or indirectly, by marketing or funding by pharmaceutical companies, and thus they have a bias toward protecting the profits of nicotine replacement products. I have no idea if this is the case with the above example, but it is certainly true of the anti-smoking groups which have called for the removal of electronic cigarettes from the market.

Some combination of these two factors is precluding many health practitioners and anti-smoking groups from giving reasonable, science-based and science-guided advice to the public on the issue of electronic cigarette use.