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Matthew J. Edlund M.D.


To Vape or Not to Vape

How can people quit smoking?

People know smoking kills. Smokers know they need to stop. Many can’t. Lots of clinicians feel smoking is the hardest addiction to end. So is using e-cigarettes a helpful way to get people to quit? Recent results appear to say yes.

Yet American public authorities, like the CDC, deeply dislike e-cigarettes. They worry that e-cigarettes will keep many smokers smoking regular cigarettes. They’re concerned that e-cigarettes are popular among teenagers, and are already creating a new type of addiction. They suspect that the vapor coming off e-cigarettes is harmful.

So what do you do?

A Tale of Two Countries

In the U.S., public health officials argue e-cigarettes just keep people smoking. They point to a meta-analysis of various small studies by Stanton Glantz and Sara Kalkhoran, done via the NIH and NCI, arguing that smokers don’t quit using cigarettes when they use e-cigarettes.

As the New York Times has pointed out in a series of thoughtful articles on the subject, that does not jive with recent statistics. Surveys in Britain argue that half of the country’s 2.8 million e-cigarette users have stopped using conventional cigarettes. Smoking is down 10% in the U.S. in the past year, with the presumption that much of that decrease must be due to e-cigarettes, as other important variables have not much changed. The Royal College of Physicians estimates e-cigarettes increase the effectiveness of smoking cessation 50-60% in people not in a clinical smoking cessation program. The evidence that c-cigarettes cut smoking are no longer anecdotal.

Why Does This Matter?

Almost half a million Americans die from cigarette smoking every year. Many of the deaths occur to non-smokers – those near smokers who themselves do not smoke, partially explaining the glass cages smokers must endure to indulge their habits in airports. Even tertiary smoke, the kind that occurs in buildings where some people smoke and others do not, has been shown to markedly impair the health of children. Smoking's toll is not just heart attacks, strokes, and tumors for smokers, but the severe effects on non-smokers.

But American public health officials are also worried about the lack of evidence regarding the second hand effects of vaping. Still, most experts do not see nicotine smoke as containing anywhere near the risk of regular cigarettes and cigars, or, so far, major secondary risk. The fear of what e-cigarettes might ultimately do to teenagers taking them up however, is high.

What is the Politics?

Complicated. The tobacco industry is looking towards any “lifeline” that can keep them in business. Besides selling cigarettes to the new middle class in developing countries, they see e-cigarettes as their other great opportunity to stay in business. They have been rolling up different e-cigarette companies, and fighting to have new regulation applied for e-cigarette use which would put Big Tobacco in the driver’s seat in controlling the industry and its growth. Despite declared protestations, as in the past they will be happy to have youth take up e-cigarettes as a “pastime,” and have aided that “success” by selling all manners of taste adulterated e-cigarettes. They see a new, long living young population getting hooked on a product that is “less bad.” Understandably, American public health officials, also worried about how widespread marijuana use will affect the brains and addictions of teens and young adults, see a coordinated storm between youngsters getting used to smoking via e-cigarettes or marijuana, then ending up using both to excess.

What Is To Be Done?

Quitting smoking is tough. Patches and lozenges work fitfully. Combining drugs like varenicline (chantix) and bupropion with cognitive behavioral groups can work, but getting people to do both is difficult and the attrition rate high. And recent public health data are declaring that e-cigarettes should help a substantial number of smokers get off regular cigarettes.

Which should be encouraged. The point has to be made that nicotine, too, can kill, but far less aggressively than do regular cigarettes. And, so far, secondary vape emanations, including what pops off young walking chimneys seen in many cities, appears rather less dangerous than standard cigarette smoke.

Still, action must be taken to prevent teenagers from vaping. There are no advantages in hooking kids on nicotine; between social media and handheld electronic devices, there are already too many habituating options.

And despite the lack of desire for the Feds to get involved in anti-trust actions involving even giant corporations, Big Tobacco should not be allowed to control the e-cigarette industry. With their financial firepower and lobbying expertise, we know where that will lead.

It is not unusual for one addiction to be replaced with another. E-cigarettes appear to let many smokers stop smoking regular cigarettes. That trend should be encouraged, while youth is educated on the dangers of the many newer forms of addiction.