Designed to look and feel like a cigarette, e-cigarettes are battery-powered devices that deliver vaporized nicotine into the lungs. For manufacturers, this new breed of cigarettes is a "win-win." In their view, smokers can reduce their harm so they don't have to "quit or die," while the cigarette industry can reinvent itself and continue to prosper. The reality for most e-cigarette consumers, however, is likely to turn out to be much messier and here's why:
E-cigarettes are not sold as a medical therapy to help smoker's quit the way nicotine replacement therapies (NRTs) are. They don't have FDA approval for that. And they are not delivered with psychosocial treatments, as are other stop-smoking medications designed to help smokers quit. In addition, the same big tobacco companies are now selling e-cigarettes as well as "traditional" or conventional cigarettes. Like many aging businesses, cigarette makers must try to hold onto their old customers while also attracting new ones. E-cigarettes provide a near-perfect vehicle to accomplish this business goal because it is clear that the vast majority (more than 90 percent in the first major e-cigarette research study released last month) of smokers will add e-cigarettes without quitting tobacco cigarettes (1). This suggests many, if not most, smokers will use e-cigarettes as a method to control their smoking in public places and private homes where it is prohibited, while continuing to smoke as before when and where they can.
An interesting finding from the new e-cigarette study was that those who quit tobacco cigarettes completely from the beginning were more likely to stay quit until the end of the study. Whereas those who only reduced tobacco cigarettes and used the e-cigarettes in addition to them, called "dual users," were "more likely" to relapse.
Smokers, like other addicts, dream of being recreational users who are in control of their drug use. Many have insecurities about quitting their emotional and chemical dependency on the cigarette itself. The way e-cigarettes are being marketed plays into the smoker's wish to control, not quit, their addiction. It reassures them they can avoid their fear of having to face the moment of truth and actually quit.
It is also important to consider the impact of new e-cigarette advertisements being shown on television (because of a regulatory loophole that exempts them from restrictions placed on tobacco cigarettes). E-cigarette ads already feature movie stars endorsing and glamorizing the product. These ads build on the long tradition of romanticizing smoking, trying to make it look as cool and desirable as possible. The Public Health Cigarette Smoking Act in 1971 banned television advertising for cigarettes. Now, 42 years later, former and current smokers are being exposed to messages encouraging their addicted brains to keep lighting up. This is a major step back for the public's health. Children, and other potential customers watching television will also inevitably be tempted to try e-cigarettes. If anyone thinks this is far-fetched, just look at the following email sent to the inbox of my 17-year-old son:
[_YouHave_beenQualified_for a smokeless_ECigStarterKit_]
In effect, e-cigarettes are not being promoted by the tobacco industry as a way out of smoking, but as a reason to not quit. Indeed, they are designed for rapid pulmonary absorption of nicotine, the route of administration most associated with developing a chemical dependency. For example, according to the National Institute on Drug Abuse (NIDA), smoking cocaine (crack) is much more addicting than inhaling cocaine through the nose. The health consequences of inhaling heated nicotine vapor into the lungs by former and current smokers using e-cigarettes are unknown. What you don't know about this product may very well end up hurting you.
A patient of mine who hadn't smoked in several weeks was feeling confident and resolved to leave it behind her. She told me the following story, "I tried one of those e-cigarettes at a wedding with some young people. It seemed really dangerous, like it would make you not want to quit."
By adding e-cigarettes, rather than subtracting tobacco cigarettes, many smokers will miss an opportunity to protect their physical, emotional and financial health.
Dr. Daniel Seidman is director of smoking cessation services at Columbia University Medical Center, and author of Smoke-Free in 30 Days: The Pain-Free, Permanent Way to Quit, with a foreward by Dr. Mehmet Oz (Simon & Schuster 2010).
(1) Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, et al. (2013) EffiCiency
and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A
Prospective 12-Month Randomized Control Design Study. PLoS ONE 8(6): e66317.
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