COMMENTARY

e-Cigs: Consensus or Controversy?

Sandra Adamson Fryhofer, MD

Disclosures

October 21, 2014

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Hello. I'm Dr Sandra Fryhofer. Welcome to Medicine Matters. The topic: e-cigs—electronic cigarettes—and the world's leading pulmonary authorities speaking out. Here's why it matters.

When I think about electronic cigarettes, several words come to mind: controversy, concerns, cost, and confusion. Controversy over whether they help people stop smoking or perhaps provide a safer alternative to smoking regular cigarettes vs concerns that e-cigs are creating a new generation of vapers who are hooked on nicotine and may become future cigarette smokers. When it comes to costs and revenue, big business—as in, big tobacco companies—have bought into e-cigs most likely for the long haul. PLoS One recently released a survey[1] of physicians' attitudes toward e-cigs as smoking-cessation devices. While 787 physicians were contacted through email, [only 413 opened the email and] only 128 [of those] responded, so the response rate was 31%. Of those who did respond, more than two thirds, 67%, thought that e-cigs were helpful as stop-smoking aids, and 35% even recommended them to their patients. All the physicians contacted in this email survey were from North Carolina, so it was by no means a nationally representative physician sample.

The American Thoracic Society, the American College of Chest Physicians, and several other international lung organizations have collectively released a physician paper on e-cigs.[2] Their paper calls for government bans and restrictions on e-cig use until the health impacts are better known. The physician paper focuses on the lack of safety data. The safety of e-cigs has not been adequately demonstrated, and potential adverse effects on human health are unknown. Don't underestimate the addictive power of nicotine! The potential benefit of e-cigs as smoking aids, in their opinion, has not been well studied or defined. Take a look at the full report from the Forum of International Respiratory Societies.

Meanwhile, JAMA just published a viewpoint article about e-cigs, vaping, and youth.[3] Here are some quotes:

"It took years to overcome the perception of smoking as cool, even after the evidence became clear that smoking is deadly."

"Vaping has been associated with a surge in nicotine use in adolescents. It's no surprise that youth are a key demographic of the vaping campaign."

"Advertisements tout flavors like bubble gum. Celebrities in the advertisements conjure images of Joe Camel and the Marlboro Man."

"Stats from the CDC show clear trends.[4] From 2011 to 2012 the proportion of high school students that have tried e-cigs has doubled from 4.7% to 10%."

The conundrum, the authors say, is how to regulate electronic cigarettes given the scientific uncertainty about the nature and extent of harms.

The American Medical Association will weigh in on this as its council on science and public health releases a report on e-cigs at its November 2014 meeting. The FDA has released a proposed rule and the comment period has closed. We all wait with baited breath, some with vaped breath, for the final FDA ruling. For Medicine Matters, I'm Dr Sandra Fryhofer.

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