Researchers at the University of North Carolina (UNC) at Chapel Hill strongly oppose suggestions that doctors should routinely recommend e-cigarettes as an alternative for their patients who smoke. Keeping in mind that the ultimate goal is to quit smoking, they argue in an opinion piece that existing treatments are more effective than e-cigarettes in helping people quit the habit.
They also emphasized that there are professional ethical concerns about providers who recommend e-cigarettes with no robust evidence regarding their safety, compared to approved anti-smoking medications.
The commentary, “Should Clinicians Recommend E-cigarettes to Their Patients Who Smoke? No.“, was recently published in the Annals of Family Medicine.
“There are very few therapeutic devices that we recommend that aren’t regulated, that have potential and real side effects, and that are addictive. There are safer and more effective smoking cessation products for the same condition,” Adam O. Goldstein, MD, MPH, said in a press release. Dr. Goldstein, the commentary’s co-author, is a UNC Lineberger Comprehensive Cancer Center member and a professor at UNC’s School of Medicine.
Smoking is an extremely difficult habit to quit, but opinions on how best to help those who do want to quit are divided.
In the same Annals of Family Medicine issue, Ann McNeill, PhD, a professor of Tobacco Addiction at King’s College London, wrote an opinion piece favoring such recommendations. In her commentary, titled “Should Clinicians Recommend E-cigarettes to Their Patients Who Smoke? Yes.“, Dr. McNeill suggested that e-cigarettes are less harmful for smokers than tobacco, more popular than other smoking-cessation approaches, and appears to be a more effective quitting aid than going “cold turkey.”
The UNC researchers, however, emphasized a noticeable lack of health safety in e-cigarettes themselves, including batteries inside the devices that have been reported to catch fire or explode, and the delivery of a similar number of “particulate matter” as found in cigarettes, which can increase the risk of cardiovascular and respiratory diseases.
They are also concerned about the lack of knowledge regarding the possible health effects of the additives used to flavor e-cigarette liquids.
“Though e-cigarettes are likely not as harmful as conventional cigarettes, a growing number of studies report that they are by no means harmless,” said Clare Meernik, MPH, a research specialist in the UNC Department of Family Medicine. “Short-term effects include exposure to toxins, reduced respiratory and lung function and burn-related injuries from exploding devices.”
The researchers also pointed out that e-cigarettes have proven to be less effective than existing treatments in helping smokers to quit.
“People are focused on should they use e-cigarettes or not. We can have a conversation about that, but part of the bigger picture is being lost,” said Dr. Goldstein. “And that is that we need be using the tools that we currently have available, including seven FDA-approved medications in combination with behavioral treatment.
“We have quit lines that provide free counseling and physician counseling to help patients come up with concrete plans for quitting and developing the skills necessary to quit permanently and to increase social support — all of which significantly increase cessation.”
The U.S. Food and Drug Administration (FDA) announced in May that its regulatory authority over tobacco products had expanded to include e-cigarettes.
Researchers believe this is a significant step in ensuring higher safety standards in e-cigarette use, including as a means of quitting.
“We need more data on effectiveness, we need more data on safety, we need technology that’s safe so the products don’t explode, we need to ensure they’re childproof,” Dr. Goldstein concluded. “Right now, we don’t know the different amounts of ingredients in these products. We don’t know about the nicotine levels that patients are getting.”