In one of the most absurd and irresponsible positions I have ever seen taken by a public health organization, the American Lung Association recently updated a public statement that urges smokers not to use e-cigarettes to quit smoking.
The two major reasons given for this advice are:
1. That the American Lung Association is "concerned about the potential health consequences of electronic cigarettes."
2. That the American Lung Association is concerned about "the unproven claims that they [e-cigarettes] can be used to help smokers quit."
The American Lung Association's advice to smokers is as follows:
"The American Lung Association is troubled about unproven claims that
e-cigarettes can be used to help smokers quit. The FDA's Center for Drug
Evaluation and Research has not approved any e-cigarette as a safe and
effective method to help smokers quit. When smokers are ready to quit,
they should call 1-800-QUIT-NOW or talk with their doctors about using
one of the seven FDA-approved medications proven to be safe and
effective in helping smokers quit."
The Rest of the Story
The rest of the story is that what the American Lung Association is essentially saying is that they would rather have smokers die than quit smoking using electronic cigarettes.
The American Lung Association's recommendation for all smokers is that they not use e-cigarettes to quit smoking. In 2015, this is a completely irresponsible position. What it means is that the ALA is recommending to smokers who have tried and failed to quit previously with FDA-approved medication and who know that they will not be able to quit successfully using those drugs that they continue to make futile attempts to quit smoking, rather than try a new approach that has worked for thousands of smokers, many of whom testify they they could not have quit in any other way.
The ALA fails to recognize that the FDA-approved medications have a dismal record of effectiveness. They work in only about 10% of cases. For the other 90% of smokers, the ALA would apparently rather they keep smoking than that they give e-cigarettes a try.
The ALA is rightly concerned about potential health consequences of e-cigarettes; however, the current evidence documents that these products are much safer than regular cigarettes. In condemning the use of e-cigarettes because of concerns over their "health consequences," the ALA is actually demonstrating a complete lack of concern over the health consequences of smoking. What the ALA is basically saying is that they are complacent with people dying from a product with known risks, but cannot tolerate the unknown risks of what has been proven to be a much safer alternative.
If a physician were to give this same advice to a patient, I would go so far as to suggest that the advice would represent malpractice. If a smoker does not believe he or she can quit using drugs, but is very excited about the prospect of using e-cigarettes to quit smoking, then no physician should discourage the patient from making such a quit attempt.
Sadly, this is exactly what the American Lung Association is doing. Their statement literally discourages smokers who believe that they can only quit with e-cigarettes from proceeding with that quit attempt. This is tantamount to advising those smokers to continue smoking rather than make the quit attempt using e-cigarettes.
The American Lung Association is also being scientifically irresponsible. First, while it is true that the long-term consequences of e-cigarette use are not precisely known, it is quite clear that there are no major acute consequences of using e-cigarettes and further, the best available evidence makes it clear that any unknown long-term consequences of e-cigarette use are dwarfed by the known consequences of continued cigarette smoking.
Second, the ALA is simply wrong in arguing that e-cigarettes have not been shown to help smokers quit. Not only have scientific studies confirmed that e-cigarettes have helped thousands of smokers quit, but the most rigorous study - a randomized clinical trial - demonstrated that e-cigarettes are at least as effective as the nicotine patch, a medication that the ALA does recommend.
In my view, the only thing that can explain this absurd position is an underlying (subconscious) hatred of smokers. Imagine if you had a loved one who was a long-term smoker and had tried unsuccessfully to quit using the nicotine patch, Chantix, Zyban, and several other FDA-approved drugs. Now they come to you and ask your advice. They have heard from many friends that e-cigarettes were effective in helping them quit. They are excited about the prospect of trying to quit using e-cigarettes. What should they do?
I contend that if you love that person, you would encourage them, with all your heart, to make that quit attempt. In my opinion, only an underlying hatred of smokers could justify recommending that they not make such a quit attempt. But this is exactly what the ALA is doing.
Sadly, while I write about the American Lung Association, my comments hold equally for the American Cancer Society, which makes the same recommendation:
"Because the American Cancer Society doesn’t
yet know whether e-cigarettes are safe and effective, we cannot
recommend them to help people quit smoking. There are proven methods
available to help people quit, including pure forms of inhalable
nicotine as well as nasal sprays, gums, and patches.
Until electronic cigarettes are
scientifically proven to be safe and effective, ACS will support the
regulation of e-cigarettes and laws that treat them like all other
The only one of the three voluntary health organizations that takes a somewhat responsible position is the American Heart Association, which at least recommends that e-cigarettes be used as a second-line therapy in patients who fail using the FDA-approved medications. The American Heart Association states:
"Some studies suggest that the use of
e-cigarettes to help smokers quit may be equal or be slightly better
than nicotine patches. The association will continue to encourage
clinicians to use proven smoking-cessation strategies as the first line
of treatment for any patient. But it reiterates in the statement that
when repeated efforts with conventional treatment fails, is intolerant,
or rejected by a patient who wants to utilize e-cigarettes to help them
quit, clinicians should not discourage their use by the patient."
That the American Lung Association and American Cancer Society do discourage the use of e-cigarettes when repeated efforts with conventional treatment fails, is intolerant, or rejected by a patient who wants to ustilize e-cigarette to help them quit is, frankly, despicable. It shows a loss of these organization's understanding of their underlying mission, which is to save lives, not to eliminate any and all unknown health risks, no matter how small. And finally, it suggests a lack of true concern for the health and lives of smokers.