Monday, May 13, 2013

Pulmonologist Unsure that Smoking is Any More Hazardous than Quitting Smoking via Electronic Cigarettes

It doesn't take a rocket toxicologist to understand that smoking burning tobacco, which contains more than 10,000 chemicals including 60 known human carcinogens - and which has already been demonstrated to cause more than 400,000 deaths each year in the U.S. - is much more harmful than vaping from a non-tobacco solution containing little more than nicotine and glycerin or propylene glycol.

If any tobacco company even hinted that smoking is as benign as inhaling vapor from a solution of propylene glycol with nicotine, that company would find itself in a courtroom the next day, defending itself against charges of fraud.

Apparently, however, a physician can make precisely the same claim with impunity.

Last week, a Stanford pulmonologist claimed that it is unclear that smoking is any more harmful than vaping. According to an article in the San Francisco Chronicle:

"There are a lot of public health questions surrounding the use of e-cigarettes, but one thing is not in question - they are becoming a popular alternative to tobacco cigarettes. ... But nicotine, whether from a cigarette or an e-cigarette, is "a known addictive agent that is not helpful in any way," said Dr. Daya Upadhyay, former assistant professor of pulmonary critical care at Stanford. So she says she encourages her patients to quit smoking entirely rather than switch to e-cigarettes. She added that e-cigarettes still contain toxic chemicals. "We can't say yet whether it's less harmful than tobacco," she said."

The Rest of the Story

Claiming that it is unclear whether smoking is any safer than vaping is equivalent to claiming that it is not clear whether smoking is any safer than using a nicotine inhaler.

Both electronic cigarettes and nicotine inhalers deliver essentially "clean" nicotine: nicotine with just a few other chemicals. Neither product has undergone long-term studies to determine whether they produce any long-term adverse effects in terms of respiratory irritation or carcinogenesis. Both products deliver nicotine via inhalation. While electronic cigarettes generally deliver nicotine from a propylene glycol or glycerin solution, nicotine inhalers generally add menthol. While the long-term effects of propylene glycol are not clear, neither are the long-term effects of menthol. The nicotine in both products is derived from tobacco, and thus contains trace levels of carcinogens: tobacco-specific nitrosamines.

Imagine, however, that a physician instructed a patient not to quit smoking using a nicotine inhaler because it is not clear that the use of the inhaler is any safer than continuing to smoke. This would almost certainly be considered malpractice.

But the rest of the story is that this is exactly the same advice that some physicians are apparently giving patients regarding electronic cigarettes. To instruct a patient that he or she should not quit smoking using electronic cigarettes because it is not clear that doing so is any safer than continuing to smoke is contrary to the overwhelming medical science. It is a claim that represents, in my opinion, malpractice. 

Perhaps the most important excerpt from the article is the following:

"Companies do not market the product as a smoking cessation tool because that would put it in a category of products, like nicotine gum or patches, that the Food and Drug Administration regulates. But a British study out last month showed that 75 percent of the 1,400 e-cigarette users who responded to a survey said they've entirely replaced tobacco cigarettes with e-cigarettes."

What is there not to like about that? Huge numbers of smokers are completely switching from tobacco to electronic cigarettes. In other words, thanks to e-cigarettes, they are successfully quitting smoking.

You would think that physicians and public health practitioners would be jumping for joy. But unfortunately, the health of smokers is not the paramount concern of all of our health professionals. Instead, the ideology of opposing anything that "looks" like smoking has overtaken in prominence the concern over the best interests of the health of smokers.

The rest of the story is that the health of smokers is being sacrificed to the blind adherence to an ideology: anything that looks like smoking is evil.

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