Friday, February 27, 2015

Study Blows Out of the Water the Claim that Substantially Reducing Cigarette Smoking Has No Health Benefits

One of the most dramatic effects that has been observed in a large proportion of e-cigarette users who are not successful in quitting completely is a substantial reduction in the amount of cigarettes that they smoke. In fact, studies have shown that a solid majority of e-cigarette users are successful either in quitting or in reducing their cigarette consumption substantially. By substantially, I mean reductions around the order of 75% to 90% or higher.

A key argument used by e-cigarette opponents to demonize these products is that these huge smoking reductions have no health benefits because unless you quit completely, you are not improving your health. The opponents have to make this argument because if it were true that these substantial reductions in smoking were improving the health of smokers, then the public health benefit of these products would be enormous.

E-cigarette opponents have therefore attacked the phenomenon of "dual use" of both cigarettes and e--cigarettes as being a bad thing that does nothing for health. This allows them to include as benefits of e-cigarettes only complete cessation.

For example, on his blog, Dr. Stan Glantz argued that reductions in cigarette consumption are not a "meaningful clinical outcome."

The truth about this question is vital, as it has implications for most of the millions of vapers in the country. If dual use has no benefits, then any vaper who is not able to quit completely might as well just return to cigarette smoking.

And, in fact, if smokers/vapers believe what researchers like Dr. Glantz are saying, they are likely to indeed return to cigarette smoking.

However, the claim that there are no health benefits of substantially reducing cigarette consumption is one of the greatest myths in the anti-smoking movement.

The Rest of the Story

First of all, even if there were no direct health benefits from substantially reducing one's cigarette consumption, it would still have health benefits. Research has demonstrated that reducing cigarette consumption enhances the likelihood of complete smoking cessation. In other words, it is a first step along a pathway to cessation. This approach works for a large percentage of smokers. In fact, a study published earlier this week showed that using varenicline for smoking reduction is an effective technique for getting smokers to quit completely. If this works for varenicline, then it would be expected to work for electronic cigarettes as well.

But it turns out that beyond the above health benefit of substantial smoking reduction, there is, in fact, a clinically meaningful direct and immediate benefit.

The dangerous myth that has been disseminated by electronic cigarette opponents is based on the observation that a number of studies have found that severe smoking reduction does not reduce the risk for heart disease and is associated with only small reductions in cancer risk.

But what these e-cigarette opponents are forgetting (or ignoring and suppressing) is that smoking does not only cause heart disease and cancer. It also causes lung disease, and there is no question that severe smoking reduction decreases the rate of progression of lung disease and produces a dramatic improvement in respiratory symptoms. Any smoker who has accomplished such a reduction can tell you this.

This fact is demonstrated by a study which reports that asthmatic smokers who switched partially to e-cigarettes, thus becoming dual users, experienced a significant improvement both in their respiratory symptoms and their lung function. Dual users also experienced a significant reduction in asthma exacerbations.

It makes sense that even severe reductions in cigarette consumption will not decrease heart disease risk because the adverse processes caused by smoking that lead to heart disease saturate at very low levels of exposure. However, the risk of cancer is generally linearly related to carcinogen dose (this has been established for lung cancer), so one would expect to see some cancer risk benefit. But the area where one would expect to see the greatest benefit is respiratory health. It is the ongoing insults due to smoking that lead to progression of chronic obstructive lung disease. Greatly reducing smoking will slow that progression. But most importantly, greatly reducing cigarette consumption will improve respiratory symptoms in smokers who are experiencing them.

In my own clinical experience, substantial smoking reduction unequivocally was associated with significant health benefits. These patients experienced a dramatic reduction in their respiratory symptoms, often making a significant difference in their quality of life.

There is no reason for e-cigarette opponents to continue to lie to the public about what they say is a complete lack of health benefit from substantial reduction in cigarette consumption. This propaganda is undoubtedly causing public health harm by convincing many smokers who cannot quit completely that it is not even worth cutting down.

1 comment:

Blogger said...

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