Quitting smoking is tough. For decades, people have turned to candies, patches, gums, and even hypnosis to try to quit. Now we have a technology that seems to reduce the health risks of a nicotine addiction and to help smokers quit. So why are American officials wary of encouraging vaping, and what should doctors know about it?
“I think there is well-established misinformation among the public because if you look at all studies – and it’s not just a U.S. phenomenon; the same is happening in Greece and Europe – you will see that most of the population, and smokers–for whom it’s more important—believe that e-cigarettes are equally or even more harmful than smoking,” said Dr. Konstantinos Farsalinos, a Research Fellow at Onassis Cardiac Surgery Center in Athens and who is a leading expert on e-cigarette use.
I spoke with Farsalinos recently and asked him about health effects and what he thinks is most important for the public to know. It’s clear that there is much misinformation that the public has heard about e-cigarettes.
In fact, so-called “reduced-risk” products are a helpful aid in quitting nicotine completely or stopping smoking.
Last week, a new study in the New England Journal of Medicine and funded by the National Institute for Health Research and Cancer Research UK, provided perhaps the strongest evidence to date about the potential benefits from the rise of e-cigarettes. Among smokers wishing to quit, those who used e-cigarettes as part of their therapy were nearly twice as likely to successfully stop smoking.
The study adds to a growing body of research that points to the opportunity that lies ahead as a result of the broad availability of e-cigarettes in the market. But there remains a complicated public health debate. The U.S. Food and Drug Administration has refused to act on approving IQOS, a heat-not-burn product widely available in Europe and Japan. I recently saw the product in use on a trip overseas, and it provides smokers the same sensation and taste of smoking a cigarette, but it heats the tobacco rather than burning it, which is what actually generates most of the carcinogens and toxins associated with tobacco.
Farsalinos discourages e-cigarette use as a means of quitting if other strategies can be used instead, but he says that, “For those people who are unable or unwilling to quit smoking by themselves or with approved medications, e-cigarettes and other alternative harm reduction products represent a viable and very important alternative—because the worst option and the worst choice is to continue to smoke cigarettes.”
Separately, Scott Gottlieb, commissioner of the FDA, has threatened tough regulatory action over what he considers an “epidemic” of youth vaping. The truth of the matter may be more complicated, and experts disagree. Clive Bates, a former anti-smoking campaigner, has written extensively on the rise of e-cigarettes. Dissecting Gottlieb’s rhetoric, Bates instead sees a positive trend that has led to greatly reduced youth smoking levels, a trend that has accelerated with the rise of e-cigarettes. And as the real harm of tobacco is with the smoking, vaping and heating is a step in the right direction, even if not perfect.
I asked Farsalinos what he might say to governments that believe there isn’t enough evidence to show e-cigarettes and heated tobacco products are better alternatives to regular cigarettes.
“If these products are not used by the population, you will never be able to gather this data. And I think we have overwhelming evidence of the greatly reduced rate of exposure of toxic chemicals from e-cigarettes compared to smoking,” said Farsalinos. “And I think this is a good enough reason to allow e-cigarettes to be available on the market and to encourage smokers who cannot quit with other methods to use e-cigarettes in order to quit.”
Farsalinos worries that the debate over reduced-risk products is ignoring the very strong evidence of harm reduction. “This debate about tobacco harm reduction has been largely an emotional debate. But I think that everyone is, more or less, ignoring the evidence, which as I said, is overwhelming, and is approaching this matter from an emotional standpoint. I think we should stick to the evidence, but of course, we should be cautious, and that’s why we are continuously monitoring how things will evolve,” he tells me.
As use of these products continues to rise, it is sure to drive continued debate over its effects on public health. But if we really want to see a decline in the illnesses and deaths that have come from smoking, we need to carefully weigh the evidence. Right now, the evidence is pointing toward great opportunity in reducing harm with e-cigarettes.
