BMJ: The
National Institute for Health and Care Excellence offers guidance for
doctors to advise people who are trying to quit smoking - that
e-cigarettes are helpful tools when trying to quit. However, emerging
evidence suggests that e-cigarettes as actually used, actually depress,
not assist cigarette smoking cessation for most users, and are a gateway
to youth smoking.
So, should they be recommended? Experts debate the issue in The BMJ today.
Smokers
are asking their doctors for advice on e-cigarette use, they want to
vape, and e-cigarettes can help smokers quit, argues Paul Aveyard,
Professor of Behavioural Medicine at University of Oxford, and Deborah
Arnott, Chief Executive of Action on Smoking & Health.
E-cigarettes
are as effective as nicotine replacement therapy (NRT) in quitting
smoking, and many people choose e-cigarettes over NRT. E-cigarettes are
popular quit smoking aids, which leads to increases in quit attempts and
quitting as a whole in England and the USA, they explain.
Some
fear that addiction from tobacco to e-cigarettes leads to continued
vaping which may be harmful. But they say, “for most vapers, the
uncertainty around harms is largely irrelevant because vaping will be
short term.”
Some
young people do experiment with e-cigarettes, but only one in several
hundred young people who have never smoked use them more often than once
a week. At a time when e-cigarettes have become more common, smoking
among young people has fallen to record lows, so the risk of picking up
smoking must be low, if it exists at all.
Concerns
have been raised about the tobacco industry’s involvement in the
e-cigarette market, however, “the evidence suggests that e-cigarettes
are not benefiting the tobacco industry because the rate of people
smoking is falling” the authors say.
“In
the UK, e-cigarettes are part of a comprehensive anti-smoking strategy
that protects public policy from the commercial interests of the tobacco
industry.” The UK health policy “promotes vaping as an alternative to
smoking and has consensus among the public health community with the
endorsement of Cancer Research UK and other charities, medical royal
colleges, and the BMA,” they conclude.
But
Kenneth Johnson, Adjunct Professor at the University of Ottawa, says
recommending e-cigarettes for quitting smoking as currently promoted and
used is irresponsible.
The
overall evidence is that e-cigarettes as actually used depress, not
assist cigarette smoking cessation. New research is replacing optimistic
speculation with evidence that indicate the limits and hazards of
e-cigarettes as a smoking aid, he says.
E-cigarettes
have a serious public health risk of addicting new generations of young
smokers, he adds. In a 2016 study among English youth (11-18 years of
age), e-cigarette users were 12 times as likely to initiate smoking
(52%) as never e-cigarette users.
“They
[tobacco companies] have a long history of aggressively using their
economic and political power to profit at the expense of public health,”
he adds. British American Tobacco has big plans for expanding the
recreational nicotine market with e-cigarettes – and cessation is not
part of the game plan.”
The
net effect of e-cigarettes on smoking cessation is negative, high
levels of dual use undermine harm reduction, and gateway risks for youth
smoking initiation are a demonstrated danger. Recommending e-cigarettes
for smoking cessation, as currently promoted and used, is
irresponsible,” he concludes.
[Ends]
Head to Head: Should we recommend e-cigarettes for smoking cessation?
https://www.bmj.com/content/
Podcast with authors: https://soundcloud.com/