You’ve been smoking cigarettes for many years and you’re convinced that they are bad for your
health. Would you be better off using e-cigarettes? That question was addressed this week in a New
York Times opinion piece by Maia Szalavitz called "The Hard Truth about Nicotine". She presents a well-reasoned case for e-cigarettes being less harmful than tobacco cigarettes and arguing for a change in public health regulations that support their use. Although I agree with much of what she writes, I would like to address some points that she omits. I will therefore delay for two weeks further discussion of the clinical benefits of applying the disease concept.
Disagreements have swirled around e-cigarettes since they first appeared in this country in 2006. Read about this timeline from the Consumer Advocates for Smoke-free Alternatives Association (CASAA). I tried to capture
some of these in a blog that I wrote in 2023 for the American Psychiatric Association called " Vaping of Nicotine: Problem, Controversy, Opportunity"
as part of their effort to educate the public about e-cigarettes.
The “pro e-cigarettes” argument centers on their being free of the
tobacco containing the toxins that have been documented to cause so many medical illnesses. The opposing negative view focuses on the potential dangers of the components of the vape fluid being inhaled, as well as the absence of long-term studies on their use. Concern about e-cigarettes being an
“on-ramp” to nicotine addiction for youth persists, although the alarming escalation of use that occurred in 2018 and 2019 has been reversed in recent years. Read more in an article from the FDA called "Youth E-Cigarette Use Drops to Lowest Level in a Decade.
In trying to resolve this debate for myself, I turn to two sources. One is the research literature, on which I will focus this week. The second – my experience with my own patients – I will describe next week. The research data on short term use is fortunately extensive. The interpretation of the data, however, is where the division of experts occurs. To give you a sense of the intensity of the
disagreement, I received an unprecedented notice prior to my attending the 2023 annual meeting of the Society for Research on Nicotine and Tobacco (SRNT), alerting me that a paper would be presented that included evidence that e-cigarettes could be more effective than traditional nicotine replacement therapy (patches, gum, and lozenges) in transitioning smokers not just off of cigarettes, but also off of nicotine completely. In other words, e-cigarettes could be used as a therapeutic agent.
This controversy has played out on an international level. For example, the National Health Service of the United Kingdom, where regulation of
e-cigarettes is tighter than in the U.S., encourages tobacco smokers to switch to
e-cigarettes and sometimes provides devices for free. U.S public health
organizations, however, consider the same evidence but do not yet support such a switch. Read this article called "Is Vaping Better Than Smoking?" from heart.org.
Adding further complexity, the tobacco industry has made substantial financial investments in e-cigarette companies and has used its substantial advertising resources to try to reduce consumers’ concerns about their use. Phillip Morris International has even established a research foundation to
study e-cigarettes. Because that industry has such a well-documented history of distorting research in order to cast doubt on the danger of tobacco cigarettes, the SRNT has recommended that its members not accept these funds, even though the financial support is badly needed.
Having been impressed by the arguments on both sides of these debates, I remain undecided. My expectation is that further studies will shed light on the issues of long-term use as well as damage from the components of the vape fluid. At the same time, I am certain that the e-cigarette industry
will continue to change their products in response to these new findings in order to reassure their current and prospective customers.
If you are concerned about your use of e-cigarettes, we would welcome the opportunity to talk with you. Please reach out to us at https://www.tripletrack.com/lets-talk.
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