Another take on electronic cigarettes

We’ve written about the pros and cons of electronic cigarettes (e-cigs) in this space. A recent report commissioned by Public Health England (PHE) states that e-cigs are about 95 percent less harmful to health than tobacco cigarettes, and should be considered in helping smokers quit.

The authors of the report were led by Ann McNeill, PhD, professor of tobacco addiction at the National Addiction Center, King’s College, and Peter Hajek, PhD, CClinPsych, director of the tobacco dependence research unit at the Wolfson Institute of Preventive Medicine in London, United Kingdom.

Refuting arguments that e-cigs could be a gateway for the youth to later smoke tobacco, the authors wrote that there’s no indication that e-cigs are “renormalizing smoking or increasing smoking uptake.”

They reported that e-cigs are attracting very few people who have never smoked, so there’s no risk of potentially increasing the number of people who might become actual smokers later on.

Other smoking-cessation experts are taking this report with a grain of salt.

Other researches by equally credible experts have drawn different conclusions and given opposing recommendations.

Draft recommendation

Also recently, an updated draft recommendation from the United States Preventive Services Task Force on behavioral interventions and medications for tobacco smoking cessation in adults, stated that it cannot yet recommend e-cigs as a smoking cessation tool.

It echoes findings of several other researches pointing out that though e-cigs may show some potential usefulness in smoking cessation, more studies are needed as to its long-term impact; and there must be stricter regulation on its marketing and sale to the public.

A report published in the Journal of the American Medical Association (Jama), coming out almost at the same time as the PHE report, stressed the “gateway issue” of e-cigs. The study was reinforced by an editorial by Nancy A. Rigotti, MD, from the Massachusetts General Hospital and Harvard Medical School in Boston. The editorial was published also in the same issue of the journal.

Dr. Risotto emphasized 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.”

Some technical flaws

However, Dr. McNeill, coauthor of the PHE report, argued that the study has some methodological or technical flaws, which make the conclusions questionable. The major issue Dr. McNeill raised was with regard to the measure to determine e-cig use and smoking.

“One of the issues we raise in our report is that of measurement,” she was quoted by 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.”

She added: “Adolescence is a time of experimentation, so what we are really concerned with is any regular use of e-cigarettes and uptake of smoking.”

Smoking cessation tool

For his part, Dr. Hajek said that the Jama study does not show that vaping with e-cigs leads to smoking. “It just shows that people who are attracted to e-cigarettes are the same people who are attracted to smoking,” he explained. He compared it with people who drink alcohol, such that those who drink white wine are more likely to try red wine compared to people who do not drink alcohol.

I maintain my personal stand that e-cigs should only be allowed as a smoking-cessation tool, which should be under the supervision of a health professional who has training on smoking cessation. It should be treated as a prescription product, and not as a “recreation” or “alternative lifestyle” device which anyone, including children and adolescents, can readily purchase even from vendors in some busy street corners.