Sunday, February 23, 2014

First-Page New York Times Article Highlights National Debate Over Electronic Cigarettes

Sabrina Tavernise put together an outstanding, insightful, and very well-written article about the electronic cigarette debate within the tobacco control movement for a front-page Sunday New York Times article.

The article outlines the opinions of two camps within the tobacco control movement. One camp sees these devices as a potentially effective way of getting smokers to quit and therefore producing tremendous public health gains. The other camp dismisses the overwhelmingly positive testimony of smokers who have been helped by electronic cigarettes and argues that they are actually, on the whole, being harmed by these products.

You know which camp I am in. So let's examine the argument being made by the other camp:

"The vast majority of people who smoke them now also smoke conventional cigarettes, he [Stan Glantz] said, and there is little evidence that much switching is happening. E-cigarettes may even prolong the habit, he said, by offering a dose of nicotine at times when getting one from a traditional cigarette is inconvenient or illegal."

So the key argument against electronic cigarettes is that for every person who they help by getting them off of cigarettes, there is another person who they prevent from getting off cigarettes.

For Dr. Glantz's argument to be correct, then it must be the case that there are literally thousands of smokers out there who would have simply quit smoking if only it hadn't been for electronic cigarettes. Readers must recognize two important points about this argument:

1. There is absolutely no evidence to support it. Not a single study has shown that smoking cessation rates with electronic cigarettes are lower than what would have been expected in the absence of e-cigarettes. In fact, the overwhelming evidence from the existing clinical trials is that while modest in magnitude, electronic cigarettes do aid smoking cessation and compare favorably against the nicotine patch, which is currently the gold standard for smoking cessation.

2. There is no reason to believe this argument is true in the first place. The percentage of smokers who quit on their own is dismally low. Moreover, the very reason why smokers are trying electronic cigarettes is because they have failed to quit smoking with existing therapies. It is ludicrous to expect that someone who has no confidence in quitting using a traditional methods is suddenly going to quit. In fact, the evidence overwhelmingly shows that without self-efficacy, most smokers are bound to fail. So we are talking about a population of smokers who are not going to quit smoking anyway. Electronic cigarettes are their last best hope. Sure, e-cigarettes are not for everyone and many will fail. But it is simply not true that those who fail are people who would have quit smoking if only they hadn't tried electronic cigarettes.

If there were any evidence that electronic cigarettes inhibit, rather than enhance smoking cessation, I too would join Dr. Glantz's camp and oppose electronic cigarettes. But such evidence does not exist. Not a shred of it so far. Not a single study suggests that electronic cigarette use results in lower quit rates than what would occur in the absence of electronic cigarette use among smokers who try these products.

If I had to characterize the two camps, I wouldn't characterize them as optimists vs. pessimists. I would characterize them as scientists who are actually talking to vapers and considering their experiences versus those who are stuck in ivory towers. I would characterize them as scientists who are pure idealists versus those who live in the real world. And finally, I would characterize them as scientists who are paying attention to the actual scientific evidence versus those who are ignoring the evidence and basing their opinions on ideology.

1 comment:

Blogger said...

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