WebMD Article Highlights Debate Over Electronic Cigarettes

Dr. MichaelĀ  Siegel

A WebMD article published yesterday highlights the debate over electronic cigarettes.

On one side of the debate are public health practitioners who argue that there is no evidence that these products are safer than regular cigarettes and that they may be leading to smoking among youth and former smokers.

The article highlights this side of the debate as follows: “This is an unproven device and we know very little about its long-term health effects,” says researcher Jennifer Pearson, PhD, MPH. She is a investigator at Legacy, an antismoking group in Washington, D.C. “E-cigarettes are probably less harmful than combustible cigarettes, [but] we don’t have data to say that and can’t talk about long-term effect.’ There are many unknowns and unanswered questions, she says. For example, have they encouraged former smokers to reignite their nicotine addiction? Are current smokers using them to quit or to circumvent smoke-free indoor air laws? And how are they affecting people who have never smoked. ‘Are they acting as gateway products?”

Pearson and colleagues have called for the removal of electronic cigarettes from the market until the FDA regulates them.

On the other side of the debate are public health practitioners like myself who argue that if one actually takes the time to review the available evidence, one will readily see that there is strong evidence that electronic cigarettes are much safer than regular cigarettes, that youth are not taking up vaping in any significant numbers, and that the primary use of these products is among smokers who are trying to quit or cut down on the amount of the harmful cigarettes they are smoking. In fact, a clinical trial demonstrated that 54% of smokers who were not motivated to quit were able to cut down by at least half on their smoking with the help of electronic cigarettes.

According to the article: “Michael Siegel, MD, disagrees. He is the associate chairman of community health sciences at the Boston University School of Public Health. They do have an important role to play in getting people to quit smoking, he says. “Taking them off of the market would be a disaster because essentially all of these smokers would be forced to go back to cigarette smoking,” he predicts. They feel like a cigarette, look like a cigarette, and you smoke it like a cigarette and see vapor when you exhale,” he says. This is appealing to a smoker who is often as addicted to the nicotine as the actual act of smoking a cigarette. They are not attracting new smokers, he says. Very few never-smokers are using these products, so all the concerns that kids and nonsmokers are going to use them seem unfounded,’ Siegel says.”

“Gilbert Ross, MD, agrees. He is the executive director and medical director of the American Council on Science and Health, a New York City-based consumer education/public health organization. ‘E-cigs contain only water vapor, safe [diluents] such as glycerin, and nicotine, in a cigarette-like delivery device, and [are] highly likely to be much less harmful than inhaling combusted tobacco smoke.'”

The Rest of the Story

The current evidence suggests that, far from causing former smokers to “re-ignite their nicotine addiction,” electronic cigarettes are helping nicotine-addicted smokers to become former smokers, or at least to cut down substantially on the amount they smoke.

There is also abundant evidence vaping is far less hazardous than smoking. I fail to understand how in July 2012, public health practitioners who have thoroughly reviewed the existence evidence can tell the public that “we don’t have evidence to say that” vaping is less hazardous than smoking.

Particularly problematic is the fact that the American Legacy Foundation investigators fail to disclose a significant conflict of interest, which is that Legacy has been a recipient of Pfizer money, and therefore has financial ties to the pharmaceutical industry, which stands to lose severely if electronic cigarettes continue to become more and more popular.

The American Legacy Foundation continues to argue that “the FDA should take electronic cigarettes off the market until it is satisfied that they are safe and effective.” This would be a devastating blow to the public’s health because it would force many ex-smokers who are currently staying smoke-free with the help of e-cigarettes to return to cigarette smoking. It would also take away a viable alternative to cigarettes for about 1.8 million people, undeniably resulting in an increase in cigarette consumption, and therefore, in disease and death.

I absolutely cannot understand such a recommendation, especially in July 2012 when we now have clinical trial evidence of the effectiveness of these products in helping even unmotivated smokers to cut down substantially on the amount that they smoke.

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