The Cure for Smoking?

Just when it seemed that decades of dedicated public health work had the tobacco industry reeling—some activists even spoke of “the end game” to smoking with smoking prevalence dropping (down to 14% of adults in the USA) and fewer adolescents taking up the habit—the industry has returned like a zombie by introducing electronic cigarettes (“e-cigarettes”).

E-cigarette devices look something like cigarettes, produce clouds of vapor like cigarettes (users “vape” instead of “smoke”), deliver potent doses of addicting nicotine like cigarettes, but lack the 4000+ toxic chemicals of ordinary cigarettes. They are well-designed, clean, are available in a variety of kiddy-appealing fruity flavors, and are marketed over social media.

One device called JUUL now reaches 70% of e-cigarette sales. It looks like a thumb drive and emits no vapor, which is why kids especially love it: they can sneak a smoke in class.

E-cigarettes promise to keep the industry in business for decades to come, particularly as adolescents who might not otherwise smoke form a new generation of nicotine addicts.

An industry lawyer in the 1960s revealed the truth in a secret memorandum when he said, “Nicotine is addictive. We are, then, in the business of selling nicotine.”  Also daunting is the fracture in the tobacco-control community, with some veteran activists insisting that e-cigarettes will be the way to help smokers quit and the “end game” achieved. To wit, the person who led the way to the WHO Framework Convention for Tobacco Control signed on to by nearly every nation, has created the “Foundation for a Smoke-Free World”. The foundation’s one-billion-dollar budget, however, is entirely funded by Philip Morris International.

The likelihood that e-cigarettes will eliminate smoking must be measured against four criteria.

1. Do they serve to promote quitting in individual smokers, thus reducing mortality?
2. Even if less poisonous than cigarettes, do they have their own hazards to health?
3. Do they serve as a gateway for regular smoking by young people who would not otherwise smoke?
4. What is the overall impact on the population prevalence of smoking and mortality?

The answers to these questions from numerous studies to date include:

1. Yes, but like many other nicotine-replacement treatments (patches, etc.), mainly in the short-term, and only making a slight difference in quitting rates. Some studies even suggest e-cigarettes make it harder to quit.
2. Yes, there is some incidence of heart and lung illness. Though unlikely to be as severe as regular smoking, it will take many years to see their full effect.
3. Yes, and not only in adolescents who are prone to risky behavior.
4. Compared to known measures of tobacco control (taxation, bans on smoking in public, counter-advertising), e-cigarettes will have only a marginal effect on reducing smoking prevalence and thus eventual fall in mortality.

Given these results, people should not be deceived by the tobacco industry promotions. E-cigarettes are not a cure for smoking; we must continue to rely on proven public health measures that address the whole population.

Reference:  Hirschhorn N. “Another Perspective on the Foundation for a Smoke-Free World.” The Lancet, 391, 25, 2018. http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(17)33312-3.pdf

Written by Ann Marie Rakovic and Norbert Hirschhorn