In the television interview, Dr. Ellen Hahn spoke about the potential use of electronic cigarettes for smoking cessation: "You do hear people claim that they have success [but] ... the bottom line is, though, that the electronic cigarette is not really a quit aid. ... There's a lot of myth and misperception and confusion about the product ... the industry is not allowed to make therapeutic [smoking cessation] claims but yet people are confused."
The Rest of the Story
Is it the "people" (i.e., smokers) who are really confused, or is it the Kentucky Center for Smoke-free Policy?
There is abundant evidence that literally thousands (if not tens of thousands) of electronic cigarette users have successfully used these products to either quit smoking or to cut down substantially on the amount that they smoke. A clinical trial has demonstrated that among smokers who were not motivated to quit, 54% were able to quit completely or to cut down by at least half on the amount they smoke.
Thus, it is quite misleading to state that the electronic cigarette is not a quit aid. For many smokers, it is indeed a quit aid.
The myth and misperception and confusion about the product to which Dr. Hahn refers is the perception that electronic cigarettes may be helpful in quitting or cutting down on smoking. The implication is that smokers are confused because many of them think that e-cigarettes could be helpful in quitting or cutting down.
But the reality is that it is the Kentucky Center for Smoke-free Policy which appears to be confused because the truth is that thousands of smokers have used electronic cigarettes successfully to quit completely or cut down substantially. More than half of unmotivated smokers were successful, so one would expect much higher rates of success among smokers who are actually motivated to pursue an alternative to their toxic cigarettes.
In light of the existing clinical trial evidence, how can one go on television and deceive the public by asserting that there is no evidence for the potential of electronic cigarettes in smoking cessation. To do so is to completely ignore the results of the clinical trial evidence, as well as to ignore the multitude of anecdotal evidence based on personal reports of ex-smokers. Ignoring the anecdotal evidence may not be all that troubling, but ignoring the clinical trial evidence is gravely problematic.
The advice from the Kentucky Center for Smoke-free Policy is irresponsible because it asserts that the many electronic cigarette users who have quit successfully using these devices should discontinue their use and take their chances with NRT or Chantix. But because a large proportion of these ex-smokers are vaping specifically because they tried NRT or Chantix and failed, this advice is tantamount to urging these ex-smokers to return to cigarette smoking. It is difficult to imagine more irresponsible medical advice.
In fact, many vapers have reported dramatic improvement in their health, such as increases in lung function and physical stamina. Discontinuing electronic cigarette use and returning to smoking is the last thing in the world these individuals should be encouraged to do. Returning to smoking will undoubtedly harm the health of these individuals and perhaps even ruin what would have been a great opportunity to keep them off cigarettes permanently.
In the second part of the salvo of scientific misrepresentation, Dr. Hahn published an op-ed in the Lexington Herald-Leader in which she asserted: "Although some people report they were able to quit smoking by using e-cigs, there is no scientific evidence that this works."
Apparently, Dr. Hahn either has not read or is ignoring the Polosa study, which provides exactly the kind of scientific evidence that she claims does not exist. In that study, electronic cigarettes were found to be useful in smoking reduction or smoking cessation in a majority of smokers who were not even motivated or attempting to quit.
In the third part of the salvo, Dr. Hahn wrote a letter to a hotel at which a vapers convention is being held this weekend. She urges the hotel not to allow vaping inside the building because of its supposed carcinogenic effects. However, in providing the evidence for those carcinogenic effects, she deceives the hotel management by failing to provide the whole story.
Hahn only notes that the FDA lab testing "found the vapor to contain several cancer causing agents." She fails to report the levels of the carcinogens detected. The rest of the story is that only trace levels of tobacco-specific nitrosamines were detected and these are a result of the fact that nicotine is derived from tobacco. The same trace amounts of tobacco-specific nitrosamines are present in nicotine gum and the nicotine patch.
I have no problem with public health advocates intervening with a hotel to try to make sure that hotel guests are appropriately protected from health hazards. However, I think it is the responsibility of those advocates to provide an unbiased picture of the scientific information, not a misleading assessment that leaves out critical information.
Finally, it appears that Dr. Hahn may have a financial conflict of interest, as a disclosure was apparently made that she has either served on a speaker's bureau or received honoraria from Pfizer (the maker of Chantix), a company which stands to lose severely if electronic cigarettes continue to rise in popularity. If accurate, then this conflict should have been disclosed in the op-ed as well as the letter.
To be sure, more research needs to be conducted on electronic cigarettes to more clearly define their effectiveness in smoking cessation and to more fully understand their precise health effects. However, notwithstanding the need for more research:
(1) It is incorrect to state that there is no evidence that these devices are useful in smoking cessation or reduction. Clinical trial evidence suggests that these products could be very useful, even among smokers with little motivation to quit.
(2) It is misleading to assert that electronic cigarettes are not a smoking cessation aid. They are for many people. What remains to be seen is exactly what proportion of smokers will be successful in quitting or cutting down substantially.
(3) It is deceptive to scare people by asserting that electronic cigarettes deliver carcinogens, without noting the level of those carcinogens and the fact that the same carcinogens are also present in nicotine replacement products.
(4) It is imperative that researchers giving national advice on electronic cigarettes disclose significant financial conflicts of interest, so that the public has the ability to take this into consideration when evaluating the validity of that advice.