Friday, December 09, 2011

Medical Scientists to Smokers: Keep Smoking, Don't Quit Using Electronic Cigarettes

In their print and radio column entitled "Medical Discovery News," two biomedical scientists have urged smokers not to use electronic cigarettes to quit smoking, even though thousands of ex-smokers have successfully quit using these devices and many have experienced remarkable improvement in their health.

The scientists express four major concerns about electronic cigarettes:
1. Nicotine delivery is variable.
2. The products contain nitrosamines.
3. The products contain other toxic chemicals.
4. Youth may find the product appealing.

The authors write: "For scientists, those are enough reasons to not try an e-cigarette. At the very least, wait until science shows what is in them before smoking one, or better yet, choose not to smoke at all."

The Rest of the Story

Let's examine each of the four concerns:

1. Nicotine delivery is variable.

So what? In what way does this create harm to users? The effect of having variable nicotine delivery is simply that the product may be less effective in smoking cessation. But there is no harm to users. In fact, variable nicotine delivery would make the product less addictive than regular cigarettes.

2. The products contain nitrosamines.

The authors don't tell you the rest of the story, which is that the level of tobacco-specific nitrosamines in electronic cigarettes are orders of magnitude lower than in regular cigarettes (about 1400 times lower than in Marlboros). Moreover, the level of tobacco-specific nitrosamines are comparable to what is found in nicotine patches and nicotine gum. But the authors do not recommend that smokers refrain from using those products. If anything, the FDA laboratory finding of only trace levels of tobacco-specific nitrosamines in electronic cigarettes shows that these products are much safer than cigarettes in terms of their carcinogenic potential.

3. The products contain other toxic chemicals.

OK. What are they? And where is the evidence that they are harmful to users? And what health effects do they cause? The components of electronic cigarettes have been studied extensively, and so far no one has suggested a particular chemical delivered by these products that has been shown to be harmful. What we do know is that while there are only a handful of chemicals in electronic cigarettes, there are more than 10,000 in regular cigarettes, including more than 60 carcinogens. Which product do you think is likely to be safer?

4. Youth may find the product appealing.

This is a valid concern. However, to date there is no evidence that youth are actually using the product. This is certainly something that needs to monitored, and youth access to electronic cigarettes certainly has to be regulated, but this is not a reason to recommend that smokers not use electronic cigarettes to get off regular ones.

Unfortunately, what these scientists are recommending is essentially that smokers should keep smoking rather than switch to electronic cigarettes. I find this to be irresponsible medical advice. There's no question that smokers are much better off quitting smoking and switching to electronic cigarettes than continuing to smoke. There is strong evidence that electronic cigarettes are much safer and there is strong anecdotal evidence that there is an immediate health improvement among smokers who switch to electronic cigarettes.

The reality is that NRT and other smoking cessation drugs are ineffective, with failure rates of greater than 90% over the long-term. In that light, it seems irresponsible to tell smokers - most of whom have tried to quit and failed with NRT - that they should continue to try using this ineffective method that has already failed them. Essentially, that is tantamount to telling them to continue smoking. I find that to be really bad medical advice.

No comments: