Wednesday, December 02, 2015

Physicians from Weill Cornell Medical College Recommend that Pediatricians Lie to Adolescents About Electronic Cigarettes

A group of researchers from Weill Cornell Medical College have recently published a review article on electronic cigarettes in which they provide recommendations for pediatricians on what to tell their patients regarding e-cigarettes.

(See: Hildick-Smith GJ, et al. A practitioner's guide to electronic cigarettes in the adolescent population. Journal of Adolescent Health 2015; 57:574-579.)

The authors appropriately recommend that pediatricians screen patients for electronic cigarette use, correct any misconceptions they may have about these products, and counsel the patients regarding cessation.

They write: "We suggest that practitioners integrate the following three steps into their routine substance use counseling provided to adolescents and preteens: (1) screen patients for ENDS use; (2) identify and correct misconceptions about ENDS products; and (3) counsel patients with regard to cessation."

In terms of the second recommendation, correcting misconceptions about electronic cigarettes, the article emphasizes that: "It is especially important to educate current ENDS users about these products by emphasizing that ENDS are in fact a tobacco product, they provide users with the highly addictive substance nicotine, the vapor does not contain just water and nicotine, the risks to their health are not yet fully understood, and a minority of teens use such products."

The Rest of the Story

While I wholeheartedly support the recommendation to correct adolescent misconceptions about electronic cigarettes, I would suggest that the way to do this is to tell the truth to the patients, not to lie to them. Yet lying is precisely what this article recommends.

Specifically, the article recommends informing adolescents that electronic cigarettes are a "tobacco product." Every adolescent will naturally interpret this as meaning that electronic cigarettes contain tobacco.

However, this is a lie. Electronic cigarettes do not contain tobacco. They do not heat tobacco. And there is no tobacco present in the e-liquids.

In fact, the most important distinguishing feature of electronic cigarettes compared to real ones is the fact that they do not contain tobacco and that they do not involve combustion. Rather, than involve heating of a solution that contains a number of chemicals that generally include nicotine, but not tobacco.

I do not understand why it is necessary to lie to adolescents in order to discourage them from vaping. Isn't it adequate for us to simply tell them the truth, informing them that vaping is not safe, that there are chemicals that could present health risks, and that nicotine itself poses a number of health hazards, including the potential for addiction.

It seems to me even worse that an article would actually recommend that pediatricians throughout the nation lie to their patients regarding the single most important fact regarding electronic cigarettes (i.e., that they differ from real cigarettes by virtue of not containing tobacco). In fact, we often distinguish conventional cigarettes from e-cigarettes by referring to them as "tobacco cigarettes." Electronic cigarettes are, in a sense, "non-tobacco" cigarettes.

Hopefully, the journal will publish a correction, noting that electronic cigarettes do not contain tobacco and that pediatricians should not be advised to lie to their patients by insinuating that e-cigarettes do contain tobacco.

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