There is a long history of the cigarette industry selling health. Early advertisements showed physicians, dentists, nurses, scientists and researchers all explaining how it was safer to smoke some new kind of cigarette (see my website for a history of cigarette ads). Early cigarettes were promoted to cure colds and asthma. Filtered cigarettes were supposed to be safer. Unfortunately, Kent produced the micronite filter, which was later found to contain asbestos as one of its ingredients (1). Low tar "light" cigarettes have now been linked to rapid increases among smokers in cases of adenocarcinoma, once a rare form of lung cancer in the periphery of the lung, because people puffed on them harder (2). Buyer beware!
Having said this, perhaps electronic cigarettes really are different. Why? In theory, having a cigarette-like experience with pure nicotine sounds promising. It sounds like a more consumer-friendly version of something we already have: Nicotine Replacement Therapy (NRT). But why not test it out first as a way to quit as well as for its safety? Why not regulate it and make sure it isn't a new way to entice children into smoking? After all why is it that e-cigs come in different flavors such as chocolate, strawberry and mint? Or perhaps e-cigs are a new way to create life-long customers for a new cigarette brand? Will most people come off of them as they come off NRT without much problem within a few months? Or will e-cigs become another financial burden to them, like their cable bill, but without the programming? What are the risks of inhaling nicotine directly into the lungs, which is a different delivery system than employed by NRT? History shows that without properly regulating and testing new cigarettes, you run the risk that you find out problems later.
For example, clinically, many people I have seen use the e-cigarette and then switch back and forth with their regular brands. They are using e-cigs to control, not quit, smoking. There are reports (3) that the amount of nicotine varies quite a bit in e-cigs from how it is labeled. The FDA found chemicals in some e-cigs which are also used in anti-freeze, as well as carcinogens in a sample it tested. The FDA also reported such unpleasant symptoms as "racing pulse, dizziness, slurred speech, mouth ulcers, heartburn, coughing, diarrhea and sore throat" (see the link at the end of this blog for more information from the FDA).
In contrast to this new, unregulated product, which is now a big and growing business on the Internet, we know that nicotine replacement therapy is a quality-controlled medication to quit smoking. You know what you are getting, that it doesn't harm your lungs or cause cancer and has minor effects on cardiovascular health. It is so safe that using NRT for two weeks before stopping smoking has recently been shown to double the chances of success at quitting with NRT, with no additional safety issues (4). This treatment has now been named Pre-Quit Treatment with Nicotine Patch (PQNP), and has already been approved in Australia and the U.K.
Researchers from the Boston University School of Public Health (5) recently came out with a new study on electronic cigarettes, which has been widely cited in the media. Based on less than one in every 20 people responding to a survey they sent out, the study's authors made some very speculative statements about the promise of e-cigs. In all usual smoking cessation studies, it is assumed that all smokers who don't respond to research follow-up are still smoking. This is a conservative, but logical assumption. In any case, if you want to compare this study of e-cigs to the research on NRT, you would have to make that assumption. The authors reported that out of the 216 e-cig users who responded, approximately 67 people said they quit, out of an original sample of 4,884. By normal methods, this equals about 1.4 percent of users, which is far less than the naturally occurring quit rate!
It is also very possible that those who responded are those who had a more positive experience with the product. We just don't know. In any case, it's not enough of a sample to know whether that smaller group is truly representative of the whole group.
Another problem with this Boston University study is we don't know yet how e-cigs compare to NRT, or to taking nothing at all, which is how most people successfully quit, because those comparisons just weren't done. So being scrupulously fair, let's say we don't know enough for the public to make informed decisions about whether e-cigs help to quit smoking, and how safe they are.
Another problem with the mad rush to promote e-cigs as "harm reduction" is the constant and, I believe, unfair bashing of NRT. People rarely are counseled on how to use NRT effectively. For example, combining the patch and the gum or the patch and the nicotine inhaler has been shown in the most recent U.S. government clinical practice guidelines (6) to be the most successful medication strategy for quitting! Yet how often is this recommendation given or taken?
Existing NRT products have been carefully tested and can be especially helpful when combined with a support program or cognitive-behavioral therapy (CBT) for smoking cessation. We already know how to help smokers quit, but the gold standard NRT plus cognitive-behavioral therapy is not offered by most health clinics, despite helping over half of all smokers quit in randomized controlled clinical trials.
Dr. Seidman is author of "Smoke-Free in 30 Days: The Pain-Free, Permanent Way to Quit" with a foreward by Dr. Mehmet Oz (Fireside Trade Paperback Original, January 2010). An audio book is available from Random House. Dr. Seidman first introduced his own program to stop smoking as a featured expert on "The Oprah Winfrey Show" with Dr. Oz early in 2008, after 20 years of helping smokers at Columbia University. For more details about the book go to www.danielfseidman.com
1. Crocidolite Asbestos Fibers in Smoke from Original Kent Cigarettes. William E. Longo, Mark W. Rigler, and John Slade. Cancer Res June 1, 1995.
2. Acheivements in Public Health, 1900-1999: Tobacco Use--United States, 1900-1999. CDC November 05, 1999/48 (43); 986-993.
3. Novel Nicotine Delivery Systems and public Health: The Rise of the "E-Cigarette". Nathan K. Cobb, Justin Byron, David Abrams, and Peter Shields. American journal of Public Health December 2010, Vol 100, no. 12.
4. Nicotine Patch Therapy Prior to quitting Smoking: A Meta-Analysis," Addiction, 103, 4 March 13, 2008: 557-563. published online.
5. Electronic Cigarettes As a Smoking Cessation Tool: results from an Online survey. Michael B. Siegel, Kerry L. Tanwar, Kathleen S. Wood. American Journal of preventive Medicine 2011. Published online.
6. Treating Tobacco Use and Dependence 2008 Update. Michael Fiore et al. Rockville MD: US Dept of Health and human Services, Public Health service, 2008.
Dr. Daniel Seidman: What to Do When You 'Just Can't Quit'
2morrowknight and Ann Tran: The Inspiring Jennifer Windrum and the W.T.F. Campaign
I am a smoker and I am highly unlikely to trade real cigarettes on the electronic ones. I purchase products on Smoking4free.com which offers good prices and good service. But with the constant tax increases on tobacco products smokers might as well start using e-cigarettes.
Nothing I've seen has given me any reason to think that health risks associated with the e-cig compare in any way to cigarettes. They aren't marketed as a cessation product (they're forbidden to unless I'm misinformed), so it makes no sense to consider them in those terms. As far as I can see, the e-cig is satisfying my addiction and removing every downside to smoking there is - not as cheap as quitting entirely, but still far cheaper than tobacco.
I won't go so far as to say the author has impure motives, but the e-cig has the potential to completely bypass both NRT and the various quitting gurus. The guy who invented it, whose name escapes me, should be presented with some kind of special award if you ask me. He's added years to my life expectancy and improved the quality of my life immeasurably. I strongly urge anyone who's still smoking cigarettes to try some form of electronic replacement. I wouldn't go back to tobacco if you paid me.
See
E-Cig
http://www.buyecig.net/E-Cigs___Safety_2OP4.html
Electronic Cigarette
http://blog.lib.umn.edu/rodr0069/myblog/2009/12/electric-cigarette-safety-who-is-telling-the-truth.html
I also carefully researched ecigs before I jumped into them. While I did find the report given by the FDA, I also found that the American Association of Public Health Physicians came out in defense of ecigs:
http://www.aaphp.org/special/joelstobac/2010/20100402AAPHPEcigLegisStatemnt.pdf
I have quit smoking cigarettes for 6 months using ecigs. That was good enough for me. I'm proof. I smoked cigarettes for 15 years. I quit and started up time after time. I could never get past the 2 month mark. I tried chantix, gum, inhalers, candy, etc...and nothing else worked. The e-cig is what allowed me to make the committment to give up tobacco. After three months of puffing on my ecig for three months I even put that away. So until there is some hardcore evidence that e-cigs are as bad or worse than cigarettes, I'll continue to stand where I am on my theory.
Prohibition is an uphill battle, and it will always be an uphill battle. It didn't work for alcohol, and it's not working with the drug war. People are going to consume what they want to consume, and if it's not hurting others, then they should have the right to.
What's next, the government places a limit on the amount of food consumed to control obesity?
LOL @ this argument. Is everything sweet-flavored for children only? Do adults not enjoy candy, cakes, and ice cream?
Nicotine is not what causes cancer; it's the myriad of other chemicals in cigarettes. Conversely, nicotine can be beneficial in certain cases (attention span, Parkinsons prevention, etc.). Everyone I know who has tried e-cigarettes has benefited. My grandpa, a COPD sufferer, saw his COPD completely disappear after switching to e-cigarettes and using a Lung Renewal cartridge. My mother no longer has a hacking cough. I agree that it needs to be regulated, but if the government were to ban e-cigs to do more research, then everyone who has experienced positive benefits will see those reverse after switching back to analog cigarettes, and some people may even die.
Regarding the anti-freeze thing, just because something is in a poisonous substance doesn't mean the substance alone is poisonous. You'll also find propylene glycol in frosting and many other products.
E-cigarettes may not always help to quit, and some brands do have some carcinogens (though it's less than the amount in cigarettes), but many smokers are still reducing their use of cigarettes, and avoiding so much risk in the process.
I told my doctor I had tried e-cigarettes and that they seemed a viable cigarette substitute, and that I seemed to require fewer of those nicotine drags with time. But articles expressing FDA concerns convinced me I'd be better off not using that approach to quitting smoking. My doctor responded by telling me to chuck the cigarettes .. now .. and go back to e-cigarettes, the lesser of the two evils by a long shot.
Haven't smoked a cigarette since, but I do drag from my e-cigarette now and then when stressed or when trying to work out a problem (experiencing the nicotine benefit without the tobacco nastiness).
The Boston University study was truly appreciated. As for the NRT program mentioned by Dr. Seidman, I agree, it's a good thing to do. The strongest of us will probably succeed with NRT, at least for a while. But the rest of us, after attempting this program, after experiencing that one final failure, should just give in and settle down with an occasional drag on an e-cigarette .. and .. ignore the naysayers, at least until it’s shown somewhere that e-cigarettes are worse for our health than the tobacco cigarettes we've grown up with.
I would agree that the FDA got the definition of an 'e-cigarette' correct, however the accuracy of the remainder of their 'study' is suspect at best. They tested only 18 cartridges and these were selected from only two companies; Njoy and Smoking everywhere. It's interesting to note that these two companies were suing the FDA. While there may have been manufacturing inconsistencies in that small industry sample, numerous subsequent studies have proven the FDA's results to be factually inaccurate. The "anti-freeze" reported by the FDA was diethylene glycol and a contaminant in only 1 of the 18 tested. It detected at trace levels, and not found in the vapor. Toxicity is determined by dosage. At the levels found by the FDA one would need to use 100,000 cartridges in a single day. At 1ml of liquid each, that would be over 26 gallons. That's assuming it's present in the vapor, which it wasn't.
E-cigarettes simply don't appeal to minors. The high entry cost of $70-$150 over the counter is prohibitive. And they simply don't have the 'cool' appeal an easily aquired $7 pack of smokes does. Given that barrier, the issue of fruity flavors as a 'gateway' enticement dwindles.
The liquid for e-cigarettes is offered in flavors for the same reason nicotine gum is. The original is wrenched. To me, the first nicotine gum tasted like chewing pepper. Furthermore the various candy, fruit and dessert flavors are quite appealing to many adults. It is more enjoyable and helps many to further disassociate the experience from smoking.
"Or will e-cigs become another financial burden to them, like their cable bill, but without the programming?" I actually spend far less on my e-cig supplies than I did on cigarettes.
"History shows that without properly regulating and testing new cigarettes, you run the risk that you find out problems later." Like the history of cigarettes which are still a federally protected product for sale on every street corner?
Yes still use nicotine, but I no longer smoke. Day by day, and week by week, I can feel my health improving. "Traditional" NRT's were simply not effective for me. The original nicotine gum tasted like pepper to me, and left a sores on my cheek and gums. Nicotine patches gave me a rash and vividly disturbing dreams, disrupting my sleep. Hypnotherapy, while partially effective was not a long term solution. I tried welbutrin, but I may as well have taken sugar pills. I never tried Chantix, by that time I was quite leery of side effects. So yes, I still use nicotine. But it's never made me want to kill myself or climb a clock tower with a high powered rifle.
Do not be to hard on the good doctor, he has spent years studying and writing on this problem...how would you feel if a 40 dollar device from china undermined all you have been saying and writing about for decades? Probably rather defensive.
I think NRT+Therapy is a valid option, but don't malign the one just to promote the other. It would be far more helpful to actually conduct these tests than to sit around and discuss the lack of tests being done.
Like some other commenters I have no real interest is giving up nicotine and would be OK with using e-cigarettes from now on. I would love to see some real studies done on the safety of e-cigarettes but common sense tells me that they almost have to be safer than regular cigarettes. Saying we don't know yet is fair but if the alternative is cigarettes almost anything you could name would be a step in the direction of health.