What the U.S. government doesn't want you to know: e-cigarettes work (BMC Public Health) - PulmCCM
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Jan 012012
 

Quitting smoking is astoundingly difficult: only about 3% stay quit at 6 months without help. Using nicotine replacement therapy increases that to 9%. The more effective but often-maligned drug Chantix (varenicline) increases it to up to 33% at six months, but after a year, smoking cessation rates even with varenicline may fall to only 11% over placebo.

E-cigarettes are a new option for nicotine replacement. Available at convenience stores and other places where cigarettes are sold, they deliver a shot of nicotine vapor without smoke. Business interests have rushed in to promote e-cigarettes, which today are not regulated as drugs or medical devices by the government. Although their marketplace popularity suggests they work, scientific data on e-cigarettes’ efficacy in smoking cessation, and their safety, have been lacking.

In a proof-of-concept pilot study, Riccardo Polosa et al provided e-cigarettes to 40 Italian pack-a-day smokers. What you need to know here is these people had no interest in quitting smoking, by their self-description. Polosa’s team called them at home (probably catching many of them mid-drag) and offered them the chance to participate. That’s it.

Results, at week 24 (~six months):

  • 22.5% were abstinent from cigarettes, confirmed by exhaled carbon monoxide (and 6 of these 9 were still using the e-cigarette).
  • A total of 55% had reduced their daily cigarettes smoked by at least half. Most got down to 3-6 cigarettes a day.
  • Overall, participants smoked 88% fewer cigarettes.
  • Participants used 2-3 e-cigarette cartridges per day.
  • Forgive me for repeating myself, but these were people who described themselves as unwilling to quit smoking at the outset.

Dry cough (32%), mouth and throat irritation (20-32%) were common among e-cigarette users (most of whom were continuing to smoke, but ascribed these side effects to the e-cigarettes).

Reaction to these results — and the apparent ability of e-cigarettes to reduce cigarette smoking without eliminating nicotine dependence — has revealed interesting fissures in the antismoking movement.

The more pragmatic, public-health “harm reduction” camp says, in effect, “Duh: Give everyone e-cigarettes.” Nicotine is not particularly harmful by itself, and every puff of an e-cigarette replaces a puff of a real cancer/lung/heart disease-causing cigarette. Ergo, e-cigarettes will save lives. This could become a similar model to methadone clinics for opiate addiction, which are accepted as distasteful but successful where abstinence approaches simply fail. As William Godshall, one of Pennsylvania’s leading anti-smoking advocates put it recently, “E-cigarettes could replace much or most of cigarette consumption in the U.S. in the next decade.”

However, there’s been a surprising counterpush by prominent governmental and non-profit agencies like the FDA, who bizarrely have tried to ban e-cigarettes (even confiscating incoming shipments to the U.S.) and when a federal appeals court ruled they had no authority to do so, fear-mongered that e-cigarettes contain “toxic chemicals” (which Boston U’s Michael Siegel demonstrates are present only in trace amounts compared to the malestrom of known poisons in cigarette smoke). The American Cancer Society and others joined the anti-e-cigarette pile-on, prompting public discussion in a New York Times article.

Given the hyperbolic rhetoric we’ve heard over the years, manufactured by the P.R. arms of nonprofit/government agencies (10 jumbo jets crashing every day, killing everyone aboard!! Each cigarette cuts 8.7 minutes off your life!!), this aggressive resistance to a likely-legitimate new smoking-reduction tool is simply flabbergasting. Sure, e-cigarettes are sketchy and weird, and no one is asking the government endorse them tomorrow. But rather than making ridiculous pronouncements about e-cigarette un-safety that I expect will soon be shown to be untrue (perhaps after large American tobacco or pharma companies take over the product segment), why can’t FDA at least throw an “atta-boy” into the doomsaying press releases? Something rational like “Quitting smoking is hard, and although the risks of e-cigarettes are unknown, they are almost certainly lower than the risks of continuing to smoke.”

Better yet, since smoking is still the #1 public health problem facing the U.S. (with obesity a close second), and with a billion people now smoking worldwide, why does the NIH not step up and write a big check for the study of e-cigarettes in hundreds or thousands of U.S. smokers? Say, a measly five or ten million bucks to start (out of its $31 billion budget)? E-cigarettes have been available for years, and there are exactly four trials listed on clinicaltrials.gov. All of them are in Italy by Polosa’s group.

It looks to me like rather than condemnation, high-profile U.S. government endorsements would be more in order. (Go with me on this for a second.) Although Barack Obama has been tobacco-free for one year, he and his doctors say, he was reported to be using nicotine gum to stay quit as recently as August 2011. I want our President to be healthy, smoke- and nicotine-withdrawal-free, and all I can say is: You can sneak into the French minister’s restroom to puff on an e-cigarette, but you can’t chew gum at a state dinner.

And in the spirit of bipartisanship: Word is, Speaker of the House John Boehner smokes like a chimney, and makes no attempt to hide it or quit. He even let Brian Williams call him a “committed smoker” in a 2011 interview, and has told reporters, “It’s a legal product. I choose to smoke it. Leave me alone.” Sounds like a perfect subject for your next study, Dr. Polosa — sign him up!

Polosa R et al. Effect of an electronic nicotine delivery device (e-Cigarette) on smoking reduction and cessation: a prospective 6-month pilot study. BMC Public Health 2011;11:786. FREE FULL TEXT

More interesting reading: Check out the long chorus of credible-sounding e-cigarette user responses to an uninformed fear-mongering anti-e-cigarette post on the popular blog KevinMD. Methinks these weren’t all written by the Chinese manufacturers.

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  23 Responses to “What the U.S. government doesn’t want you to know: e-cigarettes work (BMC Public Health)”

  1. I HAVE BEEN USING AN E CIG FOR 1 YEAR NOW, I DON’T USE IT AS MUCH AS WHEN I SMOKED REGULAR CIGARETTES. I ALSO GO FROM ZERO NICOTINE TO 6 MG OF NICOTINE, DEPENDING ON WHAT I FEEL LIKE DOING. I FEEL SO MUCH BETTER, NO SIDE EFFECTS, I HAVE LOST 60 POUNDS SINCE I QUIT SMOKING. I NOW EXERCISE, BECAUSE I CAN. NO GASPHING FOR BREATH LIKE BEFORE. I THINK THAT E CIGARETTES ARE A GOOD ALTERNATIVE TO SMOKING AND THEY DO HELP PEOPLE QUIT COMPLETELY. I HOPE THE GOVERNMENT DOES NOT TRY TO TAKE THIS AWAY FROM THOSE OF US THAT USE THEM OR WANT TO USE THEM TO QUIT SMOKING.

    • If you are still using the e-cig 12 months later, how is that “quit smoking”? You are still going through the motions and you are still addicted to nicotine!!!

      • He (or she) quit “smoking” because there is no SMOKE involved with an e-cig. There is no tobacco. There is no cocktail of 4,000 toxic substances, no carcinogens.

        Would it be nice to also break the nicotine addiction? Sure. Nicotine on it’s own presents problems, but none of them so overwhelmingly dangerous as the other substances found in real cigarettes. Nicotine is the addictive agent, not the primary problem.

      • You can’t smoke a e-cigarette… it’s water vapor the they are exhaling. They are humidifying their surroundings lol. And the water vapor may even be good to help clean up their lungs. It’s just simulating smoking, there are however plenty of vaporizers (ecigs) that look nothing like cigarettes. They only simulate cigarettes though to help smokers switch over to them, give them that familiar experience. That’s why success rates are so high… people are quitting smoking without the psychological withdrawal. I tried nicotine gum and believe me, I was dying for a cigarette and feeling sick from chewing way too many pieces, even with nicotine overload in my system I was psychologically craving the smoking experience that only e-cigs can provide.

        E-cigs, as long as they’re freely available to adults without a prescription will save countless of lives. It amazes me that anyone is complaining about that.

        Even tobacco companies will be fine, they just have to adapt, switch over to selling e-cigs and they’ll be very profitable. That’s what Newports did, their parent company now owns Blu e-cigs and they’re staying very profitable.

        • the liquid put in the e cig is not water its liquid nicotine. My husband started one over a week ago and is now complaining of shortness of breathe on week 2. its not as safe as they make it out to be.

          • it is not liquid nicotine, It has nicotine in it, yes. and nicotine does not give shortness of breath, SMOKING does.educate yourself first before you damn something.

        • While a lot of people hear vapor and automatically think water vapor. That is not true with the e-cigarette and i am a devoted e-cigatette “Vaper” if you would. So much so that I am looking for a good attorney to take my employer to court over banning my use of my personal vaporizer even as a nicotine replacement therapy while at my desk. I have been allowed to use my personal vape at my desk for almost a full year now along with another employee being allowed to use his BLU e-cig the entire time he worked here but for some unknown reason, the HR department has told me that my vaporizer is now banned as a part of their no smoking policy. If I am emitting no smoke, how am I smoking? Anyway, the vapor is from either vegetable glycerin or propylene glycol or a mix of the two. The VG (Vegetable Glycerin) gives more vapor but less taste and the PG (propylene Glycol) gives less vapor but more taste so most folks mix the 2. The VG is also only food grade or better and is thus non toxic whatsoever. The vapor also contains trace amounts of nicotine. That is it. And regular cigarettes contain thousands of toxic chemicals. In talking with several of my doctors they all say even if I never quit vaporizing it is still by far better than smoking. They hope that by stepping down the nicotine level at given intervals that I will eventually no longer even need to vape. So, anyone know a good attorney – possibly one from within the vape industry, who would take on this case on a contingency basis? I offer 50/50 on any damages received.

  2. I have been using the e-cigarette now for three weeks and have not had a real cigarette since the very first day I stared using thi device . I have been smoking for over 30 years and can’t believe how this has worked for me I now can’t even stand the smell of real cigs and am on my wife’s back to stop smoking and use the e-cig like myself .

  3. I Smoked for 10 years, tried a E cig last week and I love it. I have more energy, I sleep better, I breath better, I dont smell, I dont offend, I dont cough as much.
    Life is Better. My kids are very very happy. I dont smoke cigarettes any more!
    Wow, it was easy. Now im gonna try and quit the E cig, slowly, Wish me luck.

  4. I have used eCigs since August of 2009. I quit smoking cigarettes all together within 2 weeks of starting using an eCig. I was smoke free and using only the eCig for a year. I had cut my nicotine level down to zero within 6 months of starting using an eCig. I unfortunately succumbed to peer pressure one day and started smoking cigarettes again. I went straight back to smoking two packs per day, which is what I was doing when I switched to the eCig. However, This past New Years Eve (December 31st, 2012), I again made the decision to stop smoking. I switched back to the eCig. Today is July 1st, 2013 and I have not smoked a cigarette in 6 months. I have reduced my nicotine level down to 6mg and will be down to zero by August 1st, 2013. I still have the dry cough, ie smokers cough, but I have experienced many other beneficial effects of using the eCig instead of a cigarette. I sleep better at night. I do not feel groggy or hungover in the mornings and actually want to get out of bed. I do not get winded when I do physical work or walk uphill like I had started to do when smoking cigarettes. I feel more energetic, especially in the evenings and that has improved “relations” with my wife. I seem to have a more clear thought process and do not suffer from brain fog as I used to. I have had an increased appetite but I am keeping a close eye on it as not to over indulge and gain weight. I have had no weight gain since switching to eCigs and I am doing more physical work and have noticed that I am toning up instead of getting fat because I am doing more physical activities than I was while using cigarettes. There are a few noticeable things I have experienced that may be negative side effects of eCigs. My facial skin seems to be more oily and I have have had an increase in acne (I’m 45 years old). I have restless leg syndrome in the evenings and the “smokers cough” is the same with eCigs as it was with cigarettes. In my opinion, the negative effects of eCigs are far less worrisome than the clear and prevalent dangers of smoking cigarettes. The cost factor of eCigs vs. regular cigarettes is also a major benefit. I live in South-East Texas (Houston), a pack of cheap, off brand cigarettes here is 4.50 per pack. I was smoking 2 packs per day at a cost of 9 dollars per day. I buy a bottle of juice for my eCig for 8 dollars and it lasts me anywhere from 3 to 4 days. So going from 18 dollars for 4 days to 8 dollars is a significant savings. There are other costs associated with eCigs. The initial purchase of the batteries and the atomizing device which have to be replaced when they wear out is significant at first but over their life span the cost is minimal. I have several batteries that I currently use the I still had from 2009, a 3 dollar atomizer last me a month on average. Then there is the cost of the electricity used when recharging the batteries. I have no way of monitoring this cost, but I would think it is an insignificant amount.

    So when it’s all weighed out, I personally feel that using eCigs is a lot less hazardous to ones health than regular cigarettes. I will be nicotine free in the next month and then I will start concentrating on quitting the hand to mouth programmed habitual pattern of constantly puffing on a cigarette or eCig. Wish me luck on that…

  5. whilst is it technically “quitting” because there is no smoke, it still poses the nicotine problem, which in the end, is the real problem. E-cigs should be banned as well as smoking. both do more harm than good

    • That will NEVER happen. If you ban tobacco it will be 1000x worse than the prohibition of alcohol, countless of people will die, that’s an extremely dangerous idea.

      Let people have the freedom to use tobacco if they like but also allow people the freedom to use ecigs if they like… if they value their life they will switch over to ecigs which are much safer.

      The real problem with cigarettes is the carcinogens that causes cancer… nicotine alone doesn’t cause cancer, only in very high doses for years it can cause high blood pressure, it’s about like coffee in it’s danger level and we aren’t trying to ban coffee. However ecig users should try to within their first year switch to the lowest level of nicotine and stay there as long as they like or switch to a nicotine free cartridges if they like… either are infinitely better options rather than going back to tobacco.

      But your idea of prohibition as the solution is insanity.

    • What is exactly is the “nicotine problem” Walter . Please elaborate on the dangers of the “nicotine problem”. I do not to feel the “nicotine problem” will kill me whereas I am certain cigarettes will certainley be the cause of death for so many. As far as I know not a single death has been attributed to an E-cig.

    • The nicotine “problem”? What IS that?! The human brain has nicotine receptors, and nicotine does a lot of good things, such as increase alertness, cognitive function, etc. Nicotine is a natural substance that can be found in certain vegetables, for example, and it does not harm you unless you overdose on it, like most things. There is obviously NO nicotine “problem”, there IS, though, a “fascist mind-set” problem, and of course, the usual “government-in-bed-with-big-business” problem.

  6. I have smoked between 40-60 cigarettes per day for over 35 years. I have tried patches, gum, hypnotism, cold turkey – the lot. None of these worked. I started smoking e-cigarettes and had immediate success. Little by little I reduced the nicotine level, and have now just started puffing zero nicotine. The addiction to smoking is not just a nicotine problem – it is actually “smoking”. I can NOT agree that e-cigs do more harm than good. For many people such as myself, they can make a big improvement. Would it be better if I returned to traditional cigarettes? I don’t think so.

  7. Thank you for this article. I’m tired of reading all these articles trying to say smoking electronic cigarettes are worse than regular cigarettes. They even had me worried at first. For the first time, I’ve been able to quit while going on with my life as normal instead of a nervous wreck wanting a cigarette. I plan to ease off the e-cigs too and can certainly see being able to quit them much easier than regular cigarettes. The only reason government agencies and other big companies are knocking e-cigs is because of money. Tobacco companies are huge and make so much money. They are worried about the money. Even the cancer society seems worried they wont have as many patients or something. Only thing I can think of why they are so quick to jump all over something that is helping people steer away from the number one killer out there. Craziness.

  8. Dear God, I cannot believe Walter. What kind of a sanctimonious person are you? I have smoked for 45 years and have tried everything to quit, and for the first time have been successful. I haven’t had a cigarette in 2 weeks because of e cigarettes and that’s a record. But you don’t want us to quit because then you wouldn’t feel so good about yourself. The government doesn’t want us to quit because they’ll loose tax revenue. The American Cancer Society doesn’t want us to quit because their cause and lobbying power will be hurt. I have no idea what Walter’s agenda is, but I bet there’s a money trail somewhere. The tobacco company’s lobbyists hate them because they’re going to loose a whole boat load of money. Jesus, does anyone really care about my health. I really don’t think so.

    • I agree with chris and Barbara. Walter you need to step back and look at all of us who have tried so many different ways to quit smoking and could not do it. Now the Ecig comes along and it actually helps people. what is the harm in that? I think part of Walter’s and other people’s problem is called controlling…It is our freedom to smoke or not and or use Ecigs. you and nobody else has a right to take away our rights. I say if it is not bothering you or harming you then leave it alone. I thank God everyday that the Ecig came along, because now i am healthier, and can breathe better, my children are proud and happy for me and they are no longer worried that their mother is going to die from lung cancer. It feels so good when a doctor ask me if i smoke and i can say NO. In fact my doctor encourages me to keep on with the Ecig now that is Doctor’s advise i have no problem taking. Sorry Walter but i fully support all of us using the Ecig. Stop complaining no one is harming you.

  9. I’ve smoked on and off for 40 years. I am one of the lucky people who can generally take it or leave it but over the years I have been a regular smoker quite often too. For the last 15 years or so I only smoke when I am doing outdoors activities like hunting and fishing and then on other rare occasions. In the last few months, though, it has become regular again.

    I bought an e-cig a week ago. That’s not a long time so I can’t PROMISE that I will never smoke again but I seriously doubt it. I have never been one to enjoy the nicotine effect. When I bought the e-cig I got some 12% nicotine juice and some zero. I’ve tried both now and I find the zero equally satisfying so I’m only going to use the 12% if I crave it–which probably will never happen.

    I think there are a lot of smokers out there who are addicted to the feeling of smoke in the lungs and the hand-to-mouth action–like me. For those folks, the e-cig is wonderful. I get what I crave with no nicotine.

    It would be nice to read an article that HONESTLY speaks about the hazards of e-cigs using zero nicotine. Are there any? I’m still looking for some trustworthy info about that.

  10. Is this the land of the free? Propaganda and mind control. Wake up. Cancer is caused by negativity. How may people do you know that never smoked but still die of heart disease, cancer, diabeties, ect…. Those who don’t smoke might like to think of themselves as perfect, yet are not without flaws of some type. Seemingly they want to judge others to make themselves all puffed up with self grandality. To all non smoker – go work on your own problems and leave us alone. Look at yourself first.
    I was a smoker, now a vaper. So what! Get over it. Pull your thumb out of ur mouth.

  11. I had my first cigarette when i was 17 and my last cigarette when I was 56. I am now 62 and have been “vaping” for the last 6 years! When I bought my e-cig I threw my cigarettes away and have not touched one since! Like most people wanting to quit, I tried everything. Cold-turkey, gum, patches, even hypnosis. I was never able to completely give up the tobacco. It wasn’t the nicotine i was addicted to but the habit of smoking. With the e-cig I take a drag, inhale, and exhale vapor that looks just like cigarette smoke….THAT is what I missed every time I tried to quit! Aside from the “feeling” that I was still smoking I noticed immediately that the fifty pound rock on my chest was gone. A few weeks later I was rushing to get to work and realized that I was breathing normally instead of gasping for breath. I could run up the stairs without being winded. My blood pressure is lower, I stopped gaining weight and I was feeling better than I had in years! I realize that I should eventually give them up but then I think about all the other carcinogens I have been and are currently exposed to, just may kill me before the e-gigs do! Many of the known carcinogens have been approved by the “government”. If you want to really stir things up…try fighting against Monsanto and the use of RoundUp and GMO’s! Sorry…That’s for another discussion elsewhere!

  12. very interesting, thank you

  13. These statistics are only going to improve in coming years too! E-cigarettes don’t have any nasty side effects either..just benefits!

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