Thursday, July 31, 2014

The Tide Is Turning: More Scientific Support for E-Cigarettes

E-cigarettes get a positive health review in the new issue of the journal Addiction (here).  Quoting from the abstract:

[Electronic cigarettes, EC] aerosol can contain some of the toxicants present in tobacco smoke, but at levels which are much lower.  Long-term health effects of EC use are unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to users or bystanders.  EC are increasingly popular among smokers, but to date there is no evidence of regular use by never-smokers or by non-smoking children.  EC enable some users to reduce or quit smoking.
Conclusions: Allowing EC to compete with cigarettes in the market-place might decrease smoking-related morbidity and mortality.  Regulating EC as strictly as cigarettes, or even more strictly as some regulators propose, is not warranted on current evidence.  Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to EC as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use.

The study confirms what I and others (here) have documented about bogus claims regarding toxicants, poison episodes and gateway.  Here are excerpts:

Claim: Chemicals in EC cause excess morbidity and mortality.
Evidence: Long-term use of EC, compared to smoking, is likely to be much less, if at all, harmful to users or bystanders.

Claim: Smokers who would otherwise quit combine EC and cigarettes instead of quitting and maintain a similar smoking rate.
Evidence: EC use is associated with smoking reduction and there is little evidence that it deters smokers interested in stopping smoking tobacco cigarettes from doing so.

Claim: Young people who would not try cigarettes otherwise start using EC and then move on to become smokers.
Evidence: Regular use of EC by non-smokers is rare and no migration from EC to smoking has been documented...The advent of EC has been accompanied by a decrease rather than increase in smoking uptake by children.

Claim: EC use will increase smoking prevalence indirectly, e.g. by making smoking acceptable again in the eyes of people who cannot tell the difference between EC and cigarettes, via machinations of the tobacco industry, or by weakening tobacco control activism.
Evidence: There are no signs that the advance of EC is increasing the popularity of smoking or sales of cigarettes.

In other words, the far-fetched claims by anti-tobacco zealots are derived from thin air, not vapor.

The article is authored by established tobacco harm reduction advocates Peter Hajek, Jean-Francois Etter and Hayden McRobbie; and two Americans – Tom Eissenberg, a member of the FDA advisory panel on tobacco with a moderate record on e-cigarettes and tobacco harm reduction, and Neal Benowitz.  The latter is a surprise, as Benowitz has previously opposed tobacco harm reduction (here and here) and last year endorsed gateway speculation about smokeless tobacco (here).  It is welcome news that he has aligned his view on e-cig vapor with his position on marijuana vapor.

Drs. Benowitz and Eissenberg acknowledge research support from the National Institutes of Health and the FDA and note that the review “…does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.”

But it should.


DitchDoctor86 said...

As a reasercher. How long, in your opinion, will it take before any reliable data can be gathered on the effects of vaping?

Brad Rodu said...

This is an important question that is very difficult to answer definitively. First, most vapers are either current or recently former smokers. So they will carry residual disease risks from smoking that will be difficult to differentiate from any new adverse health effect that might be related to vapor exposure. Furthermore, while it appears that no vapor component is a cancer-causing agent, the effects on the lungs of chronic inhalation of these agents are not known, and they are not knowable. There is only one definitive way to obtain this information: observation of vapers over an extended period, perhaps one to three decades.