The e-cigarette industry says new federal rules that went into effect last week could lead to the prohibition of vaping products it says help people quit the more harmful habit of smoking cigarettes.
But two scientists at UNC-Chapel Hill say the safety of e-cigarettes isn’t proven yet and that there are more effective ways to stop smoking. Writing in the Annals of Family Medicine last month, Clare Meernik and Dr. Adam Goldstein say that while e-cigarettes have fewer toxins, they deliver the same amount of harmful particulate matter as cigarettes plus flavor chemicals that pose their own health risks.
Goldstein, a family medicine professor at UNC-CH, says doctors need guidance from the Food and Drug Administration before they can routinely recommend e-cigarettes to their patients.
“When you have regulatory standards from the FDA and data showing effectiveness and safety, then we can re-evaluate,” he said.
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Already, he said, one-third of doctors report recommending e-cigarettes to their patients who are trying to quit smoking.
The FDA has regulated the manufacture and sale of cigarettes since 2009, enforcing standards so that products are consistent and vendors follow congressional rules defining how cigarettes can be sold and marketed. Last Monday, the FDA said it also had authority over other tobacco products that include e-cigarettes, hookah and other cigarette alternatives.
The new FDA regulations require manufacturers of e-cigarettes and the nicotine-containing liquids they vaporize to report the products they make and how they are advertised. The FDA will now study those products to determine their ingredients, potential health impacts and the effectiveness of their advertising on youth and people who did not smoke before trying e-cigarettes.
In their commentary, Goldstein and Meernik say a combination of nicotine replacement therapy, such as nicotine patches, and behavioral therapy is the safest and most effective known treatment for nicotine addiction. Goldstein says many patients who have tried to quit with e-cigarettes do not seek behavioral therapy, which he compared to “giving someone medicine for a tendon injury without physical therapy.”
Goldstein says that if integrating e-cigarettes into this treatment can maintain or improve the 20 to 30 percent success rate of this treatment, he would routinely recommend it to his patients.
But until the effectiveness and safety of e-cigarettes are evaluated by the FDA, he believes that when it comes to treating nicotine addiction physicians should “recommend practices that aren’t controversial.”
Goldstein’s commentary was paired with another by Ann McNeill, professor of tobacco addiction in the National Addiction Centre at King’s College in London, that concludes doctors should recommend e-cigarettes to help patients struggling with nicotine addiction.
McNeill takes a democratic approach to public health, hoping that doctors can capitalize on the popularity of e-cigarettes to motivate smokers to quit. She cites a study showing e-cigarettes are the most popular method for smokers who want to quit, followed by going cold turkey, which has the lowest success rate. The same study shows e-cigarettes are used to quit nicotine by 10 times as many people as the most effective method of nicotine replacement and behavioral therapy.
McNeill argues that smokers are most likely to quit in a supportive, judgment-free environment. Goldstein agrees, saying there are situations where a patient may not quit with other methods. He says it is important for doctors to listen to their patients and respect their past experiences when treating a nicotine addiction. Some of Goldstein’s patients have found success with e-cigarettes, he says, but he cannot recommend it to everyone who comes into his office seeking to quit smoking.
Dr. Youn Ok Lee, a public health research analyst at RTI International based in Research Triangle Park, agrees that the commonly held idea that e-cigarettes are safer than traditional cigarettes affects their popularity.
“There are a lot of misconceptions about e-cigarettes,” Lee said. “Many believe it is ‘harmless water vapor,’ which is not correct.”
Lee’s research focuses on the popularity of e-cigarettes with young people. She says e-cigarettes are the most common nicotine product used among middle school and high school students. Advertising for e-cigarettes reaches 7 out of 10 teenagers, according to the CDC, and Lee says her research shows teens react positively to e-cigarette advertising. She and other public health experts like Goldstein want to know “how many kids who would have never smoked are smoking e-cigarettes?”
Lee says another draw for teens are the flavored liquids used in e-cigarettes. An FDA and NIH study showed that 70 to 80 percent of e-cigarette users prefer flavored liquids and that flavor was commonly cited as a reason for using e-cigarettes.
When it comes to applying FDA standards to e-cigarettes, flavored liquids provide another hurdle.
“With thousands of different flavors on the market, there are potentially thousands of different chemicals that have to be studied,” Lee said.
Under the FDA regulations, e-cigarette manufacturers will be required to disclose the products they make and how they are advertised by the end of 2016. They’ll also be required to submit the ingredients used to make their products by Feb. 8, 2017. And in June 2018, e-cigarettes will need to be advertised and sold with an FDA health warning label, like other tobacco products.
Stephen Ginley: 919-829-4520