E-Cigarettes

Electronic (e)-cigarettes are about 95% less harmful to health than tobacco cigarettes, and they might be useful in helping people kick the smoking habit, according to a report commissioned by Public Health England (PHE)

The authors of the report also found that regular users of e-cigarettes are almost exclusively adults who are already smokers. In fact, the rate of youths and adults who smoke cigarettes has continued to decline in England, and there is no current evidence that e-cigarettes are “renormalizing smoking or increasing smoking uptake,” they write.

At first glance, the PHE report appears to be at odds with research that has drawn different conclusions on various issues related to e-cigarettes.

Given the growing popularity and increasing use of e-cigarettes, questions remain about their effects on teens and young adults. In fact, a study published at the same time as the PHE report arrived at a different conclusion about the gateway issue (JAMA. 2015;314:700-707).

In an editorial accompanying the JAMA study (2015;314.673-674), Nancy A. Rigotti, MD, from the Massachusetts General Hospital and Harvard Medical School in Boston, explains that the study provides “the strongest evidence to date that e-cigarettes might pose a health hazard by encouraging adolescents to start smoking conventional tobacco products.”

But Dr. McNeill takes issues with the conclusions reached in the JAMA study.

“One of the issues we raise in our report is that of measurement,” she told Medscape Medical News. “It is not the same to equate ‘ever use’ with use, as ever use can mean that someone had just tried an e-cigarette once.”

In the JAMA study, that was the measure of e-cigarette use and smoking. “Adolescence is a time of experimentation, so what we are really concerned with is any regular use of e-cigarettes and uptake of smoking,” Dr. McNeill explained.

Dr. Hajeck said he agrees that the JAMA study does not show that vaping leads to smoking. “It just shows that people who are attracted to e-cigarettes are the same people who are attracted to smoking,” he pointed out. “People who drink white wine are more likely to try red wine that people who do not drink alcohol.”



Aside from the gateway issue, the report highlights the overall safety of e-cigarettes and their possible use as smoking-cessation agents.

In the United Kingdom, e-cigarettes are being positioned as a possible tool to help with smoking cessation, whereas in the United States, e-cigarettes are more about lifestyle, according to the report. In the United States, “They can’t be marketed as cessation aids because the FDA won’t allow it.”

My Take:
This is a prime example of how study results are so dependent on how the study is framed. I believe the tobacco industry is concerned about e-cigarettes being an effective tool to reduce cigarette smoking. Therefore, the studies conducted in the U.S. to date, are designed to show that e-cigarettes increase rather than decrease cigarette smoking. Even the FDA has hampered the potential benefit by disallowing advertising e-cigarettes as a tool for smoking cessation.

The Bottom Line:
Look to future studies the the U.K. that will document their efforts to reduce tobacco consumption outstrip those here in the U.S. I believe e-cigarettes to be an effective tool for smoking cessation. Clinically, I have witnessed a 50% success rate in my practice. Although, that’s a small sampling of the population, it is considered a major component of evidence based medicine.

Source: August 26, 2015 Medscape