A simple question, you might think.
But apparently not so simple to anti-smoking advocates in South Carolina, who have come up with quite a strange definition of their own.
Take this scenario:
A 56-year old man, who has smoked 2 packs per day for 35 years and has unsuccessfully tried to quit using nicotine patches and gum tries electronic cigarettes in an attempt to quit smoking. He succeeds and is able to go from smoking about 40 cigarettes per day to smoking 0 cigarettes per day. In fact, he quits smoking and is abstinent from cigarette smoking for twelve months.
Question: Has this individual quit smoking?
Most reasonable people would answer A. Yes, this smoker went from smoking 2 packs per day to smoking 0 cigarettes per day. He has not smoked for 12 straight months. So yes, of course, he has successfully quit smoking.
Not so, according to some anti-smoking advocates in South Carolina. They argue that since he continues to vape, he has not quit smoking. He is still a smoker in their eyes.
The Rest of the Story
According to an article in the Times and Democrat (Orangeburg, SC), two anti-smoking advocates in South Carolina believe that if someone quits smoking using electronic cigarettes, she has neither quit smoking nor discontinued tobacco use:
"Melissa Watson, a Columbia health counselor ... believes e-cigarettes, while potentially helpful from solely a harm reduction standpoint, are not useful in actually kicking the habit. She said the problem with e-cigarettes is they are designed to simulate smoking, while the commonly used nicotine gums and patches are not. “What’s the end goal?” she asked. If the patient intends to fully quit tobacco use, she said, e-cigarettes are not the way to go."
So Watson is saying that if someone successfully quits smoking using e-cigarettes, she has not actually quit smoking, even though she no longer uses any combusted tobacco product, or any tobacco product for that matter. Watson argues that this ex-smoker is still a tobacco user, even though there is no tobacco in the electronic cigarette.
But that's not the end of the story.
According to the article: "Dr. Scott Strayer of the University of South Carolina Medical School shares a similar opinion. He noted that no studies yet prove that e-cigarettes are healthier or helpful in quitting. A former smoker of 15 years, Strayer said quitting is about “behavior change.” This can be difficult to achieve when still reliant on smoking something, even if it is electronic."
So again, Dr. Strayer as well believes that if a 40 pack-year smoker quits by using non-tobacco electronic cigarettes, he has not actually changed his behavior. He hasn't achieved the desired behavior change (which was quitting smoking).
So much for reason and logic.
Now you can see the problem we are facing in public health. The ideology against the physical act of holding something that looks like a cigarette is so strong that some anti-smoking advocates don't even recognize that someone who has quit smoking using electronic cigarettes has quit smoking. These anti-smoking advocates don't even appear to understand that a person who quits smoking using electronic cigarettes is no longer using tobacco.
Apparently, what bothers these advocates is the simple act of doing a behavior that looks like smoking.
It is also disheartening to see that Dr. Strayer is not convinced that smoking is any more hazardous than vaping. Hopefully, he is not telling his patients what he apparently told the Times and Democrat: that there is no evidence that cigarette smoking is any more hazardous than using a non-tobacco, non-combustion product that has been demonstrated to have levels of carcinogens that are orders of magnitude lower than cigarettes and which have been demonstrated not to impair acute lung function.
Any physician who advises his patients not to try to quit smoking using an electronic cigarette because they may not be improving their health by quitting in this way is not only committing malpractice, in my opinion, but she also needs a remedial course in basic chemistry and toxicology.
There is plenty of room for debate about the appropriate role for electronic cigarettes in smoking cessation strategy. However, if opponents of electronic cigarettes can't even acknowledge that someone who quits smoking using electronic cigarettes has indeed quit smoking and no longer uses tobacco, then there is no basis for rational, scientific discussion.