E-Cigarette Opponents Recommend that Smokers Use a Drug With Known Deadly Effects, Rather than a Product With No Known Toxicity

Authors of a recent Perspective article in the New England Journal of Medicine - both physicians - recommended in that article that smokers trying to quit should use approved smoking cessation drugs rather than electronic cigarettes to help them get off of cigarettes. In particular, they advocate for the use of Chantix instead of electronic cigarettes as a pharmaceutical product for smoking cessation.

According to the article: "In reality, both smokers and e-cigarette users have many alternatives: multiple nicotine products, approved, regulated, and deemed to be safe and effective by the FDA, are already widely available (in addition to other effective cessation tools, such as varenicline, bupropion, telephone quit-lines, and Web-based services)."

Thus, the article recommends that smokers use varenicline (Chantix) instead of electronic cigarettes to help them quit smoking and it also recommends that ex-smokers who have quit using electronic cigarettes discontinue electronic cigarette use and instead use drugs like Chantix.

The Rest of the Story

The rest of the story is that this article is recommending that electronic cigarette users switch to a drug (Chantix) with known, severe potential toxicity, including the risk of death, rather than remain off cigarettes using a product with no known toxicity (beyond the risks of long-term nicotine use).

While Chantix has been linked to more than 200 deaths (from suicide) and thousands of other severe adverse side effects, electronic cigarettes have been linked to no deaths and no severe adverse side effects.

Why, then, would these physicians recommend that ex-smokers discontinue a product with no known toxicity and switch over to a product with well-documented, potentially fatal toxicity? In my view, this makes no sense at all.

The only possible explanation I can even begin to come up with is a financial one: one of the authors of the article has received funding in the past from Pfizer, the maker of Chantix. As I pointed out earlier, Dr. Abrams has received grant funding from multiple pharmaceutical companies that have investigated or manufactured smoking cessation drugs, including Eli Lilly, Dupont Merck, Glaxo-Wellcome, SmithKline Beecham, Sano Corporation, Bristol-Myers Squibb, Knoll Pharmaceuticals, and Pfizer.

Interestingly, the research funded by Pfizer was a pair of studies specifically designed to test the effectiveness of varenicline (Chantix) for smoking cessation. With this direct conflict of interest then, it may not be as difficult to imagine why there could be an appearance of bias in the recommendation that electronic cigarette users put down their devices with no known toxicity and switch over to a drug that appears to have killed hundreds of people.

My additional question is this: why bother studying the toxicity of electronic cigarettes if we have a drug we already know is killing hundreds, but these researchers are not calling for it to be removed from the market? How many deaths from electronic cigarettes would have to occur in such research before it would warrant removal from the market? Since Chantix is already killing hundreds but not being removed, what is the point of even studying electronic cigarette toxicity?

It appears to me that the recommendations being made are not science-based, but are ideological and/or influenced by financial conflicts of interest. The science base simply doesn't support recommending that people use a drug with known severe toxicity and over 200 associated deaths over a product that has so far not been associated with a single death or severe adverse event.

If readers can help me make sense out of this recommendation, please help. I am struggling to understand it.