"Quit Our Way or Die": Lifestyle Control in the Modern-Day Tobacco Control Movement

There is strong evidence that smokers who switch to e-cigarettes completely are more likely to succeed in quitting than smokers who use nicotine replacement therapy (NRT). There is similar evidence that smokers who try to quit using e-cigarettes are more successful than those who utilize smoking cessation counseling. In fact, the difference in effectiveness between the use of daily e-cigarettes and the use of nicotine replacement therapy is large: there is about a 2-fold difference. In other words, smokers who try to quit by switching completely to vaping are twice as likely to succeed than those who try to quit by using nicotine replacement therapy.

The Rest of the Story

In spite of the evidence establishing daily vaping as a highly effective method for smoking cessation, I was recently surprised to see that most health organizations--including smoking cessation clinics--are recommending that smokers should NOT attempt to quit smoking using electronic cigarettes, even if the individual is strongly motivated to quit by switching to vaping, specifically prefers vaping to nicotine replacement therapy or other medications, and has tried to quit using NRT or medications in the past but failed.

Here are just a few of the many health organizations and smoking cessation programs that don't want smokers to succeed in quitting by using e-cigarettes. It is what I call the "Quit Our Way or Die" approach to smoking cessation.

Partial List of "Quit Our Way or Die" Organizations

1. UCSF: The University of California at San Francisco provides a list of treatment options for smoking cessation, but daily use of electronic cigarettes (that is, switching completely to vaping) is not among the options. Shamefully and irresponsibly, their medical advice is based on a 2008 reference and apparently ignores all of the changes in scientific evidence in the past 16 years. Even in their current smoking cessation guidebook, e-cigarettes are not mentioned, even as a possible smoking cessation aid, and in fact, patients are specifically advised not to use e-cigarettes in a quit attempt (even though more than 3 million people have used this approach successfully). 

2. American Cancer Society: The American Cancer Society denies that electronic cigarettes can help people to quit smoking and recommends against their use in smoking cessation, even though more than 3 million people have used this approach successfully: "E-cigarettes are not approved by the FDA as aids to help people stop smoking. This is because there is not enough research to show they help people stop using tobacco. On the other hand, there are other proven methods that can help you quit using tobacco. This includes FDA-approved nicotine replacement and other medicines. There is a lot of evidence showing that these methods work. They are safe and effective, especially when combined with counseling. Some people choose to try e-cigarettes to help them stop smoking. But e-cigarettes have as much if not more nicotine as regular cigarettes and other tobacco products." The reason e-cigarettes are not approved by the FDA as aids to help people stop smoking is not because there is a lack of evidence that they can help people stop smoking, but because no company has ever applied for FDA approval of e-cigarettes as smoking cessation devices. Further, the fact that e-cigarettes have nicotine, just like regular cigarettes, is not a reason to avoid them; on the contrary, it is the exact reason why these products work. NRT products contain nicotine, but the American Cancer Society is not discouraging people from using those products.

3. American Lung Association: The American Lung Association denies that electronic cigarettes can help people to quit smoking and recommends against their use in smoking cessation, even though more than 3 million people have used this approach successfully. The American Lung Association states: "Despite what e-cigarette, vape and other tobacco product companies want you to believe, switching to use of any other tobacco product is not quitting. E-cigarettes are still tobacco products, and FDA has not approved any e-cigarette as a way to quit for good. In fact, the FDA must crack down on the unproven health claims made by the e-cigarette industry because it's confusing people who want to quit." Thus, the American Lung Association doesn't even consider single-use vapers as having quit smoking. This is absurd. If you have switched from smoking to vaping, then you have quit smoking. What the American Lung Association is telling vapers is that if you have quit smoking by switching completely to vaping, you might as well go back to smoking because what you did doesn't count.

4. American Heart Association: The American Heart Association also denies that electronic cigarettes can help people to quit smoking and recommends against their use in smoking cessation, even though more than 3 million people have used this approach successfully. The American Heart Association states: "E-cigarettes are sometimes marketed as a way to quit smoking, but there is not enough scientific evidence that it works. One study reported adult smokers who used e-cigarettes were 28% less likely to quit successfully. The American Heart Association recommends using proven methods to quit smoking." E-cigarettes are a proven way to quit smoking. And there is plenty of strong scientific evidence that they work; in fact, they work more effectively than NRT.

Final Thoughts

I have to seriously say that I have so much respect for people who have quit smoking by switching to vaping. To do this in an environment when health authorities all around them are urging them not to and telling them how dangerous it is, but to have the wisdom and insight to discount that advice and instead rely on their own research and the experiences of friends, family members, vape shop owners, and others in the vaping community is wise, courageous, and admirable.

But while I praise vapers who have quit smoking, so many of my tobacco control colleagues are lambasting them for it. Moreover, they are completely ignoring their experiences, calling them nothing but anecdotes. Of course, when you have 3 million anecdotes, you can call it rock solid evidence.

The rest of the story is that most of the major medical and health organizations have deviated from the practice of medicine and public health. Instead, they are practicing lifestyle control. You have to quit their way or you haven't actually quit. Who gives them the right to define what smoking cessation is? How can they possibly argue that quitting smoking by switching to e-cigarettes isn't quitting smoking? Apparently, it isn't the health of smokers that these organizations really care about. It is controlling people's lifestyles and telling them how they should be living their lives, regardless of whether that advice is in the best interests of the health of the public.