An article written by physicians out of Brigham and Women's Hospital in Boston, published in this month's issue of the Annals of Internal Medicine, urges physicians to counsel patients against the use of electronic cigarettes, even as strong anecdotal evidence suggests that these devices may literally be a life-saver for smokers who are unable to quit via traditional means.
The article implores that: "Physicians should be aware of the popularity, questionable efficacy claims, and safety concerns of e-cigarettes so that they may counsel patients against use and advocate for research to inform an evidence-based regulatory approach."
At the same time, according to yesterday's article from the Bloomberg News web site, the American Lung Association is also urging smokers not to use electronic cigarettes as a smoking cessation tool.
According to the article: "Unless e-cigarette companies can prove the gadgets are safe, “people should not use them because we don’t know what they are,” said Paul Billings, vice president of national policy and advocacy at the American Lung Association in Washington."
The Rest of the Story
In instructing patients or smokers in general not to use electronic cigarettes, what these physicians as well as the American Lung Association are saying is that they would rather smokers continue to smoke cigarettes than to quit smoking via the help of electronic cigarettes.
The reality is that the majority of smokers are not going to be able to quit smoking using traditional therapy (i.e., pharmaceutical aids). For this overwhelming majority of smokers, the physicians and the Lung Association are saying: "Don't try electronic cigarettes. We don't know what they are. Stick with the real ones. Don't put down your Marlboros, Camels, and Newports."
I would argue that this advice is irresponsible and misguided. The best available evidence suggests that electronic cigarettes are much safer than regular cigarettes. The levels of carcinogens are orders of magnitude lower. There is no evidence that they cause lung disease. There are no specific safety concerns that anyone has pointed out, other than the nicotine, which is of course also present in nicotine replacement products.
It is even more irresponsible to tell the public: "We don't know what they are." What that is tantamount to saying is: "I didn't take the time to research electronic cigarettes and to review the twenty plus studies on the product."
We actually know exactly what electronic cigarettes are and what they contain. We have extensive reports from gas chromatographic mass spectrometric analyses which have determined the components in both the electronic cigarette cartridge liquid and in the produced vapor. So far, nothing has turned up which suggests that the product poses anything near as much risk as cigarette smoking. In fact, nothing has turned up yet which suggests that the product poses risks beyond that attributable to the nicotine in the product.
Do we need formal clinical trials to determine for certain the safety profile of electronic cigarettes? Yes. But that doesn't mean that we have no idea what is in them or what the safety profile is for the constituents in them.
The American Lung Association has the right to its own opinion about electronic cigarettes, but it is truly irresponsible to offer advice to smokers that is based on ignorance. It is irresponsible to offer advice to smokers when they haven't bothered to seek out and read all the available evidence that has been accumulated, including the twenty plus studies that have examined electronic cigarettes to determine the specific chemicals that they contain.
I believe it is also irresponsible of physicians to advise smokers to continue smoking rather than to quit by virtue of electronic cigarettes. That is almost tantamount to a death sentence for many smokers. Many smokers who have quit smoking with the use of e-cigarettes have testified to the immediate and perhaps life-saving improvement in their health which they have experienced. To deny these potential benefits to smokers is tantamount to malpractice.