NEJM editorial: e-cigarette users should resume smoking for their own good

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A New England Journal of Medicine (NEJM) perspective piece on electronic cigarettes (e-cigarettes) would have you believe that FDA-approved cessation methods like the patch are a superior means of quitting smoking compared to e-cigarettes and, therefore, smokers should not rely on these relatively new electronic devices to kick the habit. But as ACSH s Dr. Gilbert Ross points out, the efficacy of these FDA-approved nicotine replacement products can be interpreted in one of two equally dismal ways: either they double cessation rates, from cold turkey success rates of about 7 percent to around 15 percent or they have an 85 percent failure rate. Such success rates would be unacceptable if applied to a drug therapy; why should we tolerate that level of cessation when the effects of smoking are so dire? he asks.

The NEJM perspective piece was written by Dr. Nathan K. Cobb and Dr. David B. Abrams, who are affiliated with the American Legacy Foundation, an anti-smoking advocacy group funded by the tobacco industry via the 1998 Master Settlement Agreement; their article claims that the safety of the nicotine solution used in e-cigarettes is untested and unregulated. The authors also allege that the device does not reliably deliver nicotine and is, therefore, unlikely to be effective as a cessation device. So their solution, says Dr. Ross, is to stick with the FDA-regulated forms of nicotine delivery such as patches, gum, lozenges, nasal spray, or the existing FDA-approved inhaler in spite of their dismal long-term quit rates.

Dr. Ross finds the authors assertions misleading and contradictory. Their commentary," he says, "completely distorts what we do know about e-cigarettes and conjures up arguments and concerns usually focused on imaginary threats to children to support their claim that these devices aren t safe and should be subject to stricter regulations.

The authors also worry that e-cigarettes will become a bridge product for youth, yet as ACSH s Dr. Ruth Kava points out, the relatively heavy price tag would likely deter most people in this age group. She adds that the article seems to use the word addiction as a scare tactic, in that they claim that e-cigarettes may be perpetuating nicotine addiction. But what the authors fail to acknowledge a common error among those who oppose tobacco harm reduction, she observes, is the condition of the 45 million Americans currently addicted to nicotine that's delivered via the undeniably deadly cigarette.

ACSH continues to take the stance that e-cigarettes pose a much lower health risk than traditional cigarettes because they do not generate the cancer-causing tobacco combustion products of cigarette smoke, while at the same time, they more safely mimic the addictive behavior that many smokers find so difficult to overcome.